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Reis LMDS, Pinheiro AADC, Silva Júnior MAD, Gonçalves CP, Santana NN. Impact of telehealth during the COVID-19 pandemic on clinical and nutritional conditions of adolescents with cystic fibrosis. J Bras Pneumol 2024; 50:e20230397. [PMID: 38808828 PMCID: PMC11185150 DOI: 10.36416/1806-3756/e20230397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
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Blanco-Orive P, Del Corral T, Martín-Casas P, Cebrià I Iranzo MÀ, Godoy-Nieto C, López-de-Uralde-Villanueva I. Spanish adaptation and validation of the child- and parent-report cystic fibrosis questionnaire-revised (CFQ-R). Pediatr Pulmonol 2023; 58:3447-3457. [PMID: 37701960 DOI: 10.1002/ppul.26671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/31/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To evaluate the psychometric properties of the Spanish versions of the child- and parent-report cystic fibrosis questionnaire-revised (CFQ-R). METHODS A Spanish adaptation of the CFQ-R was performed; 68 children with CF (6-13 years) and their parents completed the child- and parent-report CFQ-R, respectively, and the Revidierter KINDer Lebensqualitätsfragebogen (KINDL) questionnaire. The CFQ-R was completed twice, 7-10 days apart, and its psychometric properties were analyzed. RESULTS The internal consistency of both CFQ-R versions was adequate (child-report version, Cronbach's α >.60 for all domains except "Treatment Burden" [α = .42] and "Social Functioning" [α = .57]; parent-report version, α > .60 for all domains except "Social Functioning" [α = .58]). For the child-report version, the lowest measurement error was for "Emotional Functioning" (standard error of measurement [SEM]: 8.3%; minimal detectable change [MDC90 ]: 19.3%), and the highest was for "Body Image" (SEM: 15%; MDC90 : 35%). For the parent-report version, the lowest measurement error was for "Physical Functioning" (SEM: 7.1%; MDC90 : 16.5%), and the highest was for "Weight" (SEM: 17.2%; MDC90 ; 40.1%). The correlation between the versions showed higher agreement for the domains related to observable signs ("Physical Functioning") and lower agreement for "Emotional Functioning." There was a significant correlation between the CFQ-R and KINDL. CONCLUSION Both the child- and parent-report versions of the Spanish CFQ-R have adequate reliability and validity for clinical and research purposes. These versions can be administered before and after starting modulator therapy to assess its effect on daily functioning. The MDC90 can help identify, with a high probability, whether real changes have occurred in the quality-of-life subscales in children with CF.
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Affiliation(s)
- Paula Blanco-Orive
- Doctorate in Health Care, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Tamara Del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, IdISSC, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid (UCM), Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, IdISSC, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid (UCM), Madrid, Spain
| | | | - Cristina Godoy-Nieto
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Barcelona, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, IdISSC, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid (UCM), Madrid, Spain
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DiFiglia S, Georgiopoulos AM, Portenoy R, Seng E, Berdella M, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Walker P, Wang J, Yonker LM, Buehler B, Chaudhary N, Esposito C, Frantzen T, Henthorne K, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. Palliative care needs among outpatient adults with cystic fibrosis: Baseline data from the Improving Life with CF trial. J Cyst Fibros 2023:S1569-1993(23)01664-8. [PMID: 37951787 DOI: 10.1016/j.jcf.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Little is known about the burden of illness experienced by people with cystic fibrosis (pwCF) since the advent of CF transmembrane conductance regulator (CFTR) modulator therapies. Studies that characterize the nature of illness burden are needed to inform the development and implementation of palliative care programs that can serve this population and address quality of life concerns. METHODS Adults with CF treated at five U.S. CF centers were surveyed to obtain baseline data for the Improving Life with CF primary palliative care implementation trial. Consenting patients completed the Integrated Palliative Care Outcome Scale (IPOS), a multidimensional measure of unmet needs for palliative care. Sociodemographic and clinical information was also obtained. The associations among these variables were examined through bivariate and multivariable analyses. RESULTS Among 256 adults, the most distressing symptoms included not feeling "at peace", communication difficulties with family/friends, anxiety over illness or its treatment, and a lack of energy. In the multivariable analyses, CFTR modulator use was associated with lower IPOS total and physical symptoms scores; female sex and increased hospitalizations were associated with higher scores. Increased age and history of distal intestinal obstructive syndrome were associated with higher IPOS physical symptoms scores. CONCLUSIONS These findings illuminate the nature of illness burden for pwCF in the era of CFTR modulator therapies. Although illness burden is positively affected by modulator therapy, there is a continuing need for palliative care to address physical, emotional, and spiritual distress, and the communication and practical needs experienced by adults with CF.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, New York, NY, United States; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria Berdella
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Janice Wang
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Brian Buehler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Esposito
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Theresa Frantzen
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | | | - Amy Plachta
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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Glasscoe C, Hope HF, Lancaster GA, McCray G, West K, Patel L, Patel T, Hill J, Quittner AL, Southern KW. Development and preliminary validation of the challenges of living with cystic fibrosis (CLCF) questionnaire: a 46-item measure of treatment burden for parent/carers of children with CF. Psychol Health 2023; 38:1309-1344. [PMID: 35259034 DOI: 10.1080/08870446.2021.2013483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/29/2021] [Accepted: 11/28/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Treatments for cystic fibrosis (CF) are complex, labour-intensive, and perceived as highly burdensome by caregivers of children with CF. An instrument assessing burden of care is needed. DESIGN A stepwise, qualitative design was used to create the CLCF with caregiver focus groups, participant researchers, a multidisciplinary professional panel, and cognitive interviews. MAIN OUTCOME MEASURES Preliminary psychometric analyses evaluated the reliability and convergent validity of the CLCF scores. Cronbach's alpha assessed internal consistency and t-tests examined test-retest reliability. Correlations measured convergence between the Treatment Burden scale of the Cystic Fibrosis Questionnaire-Revised (CFQ-R) and the CLCF. Discriminant validity was assessed by comparing CLCF scores in one vs two-parent families, across ages, and in children with vs without Pseudomonas aeruginosa (PA). RESULTS Six Challenge subscales emerged from the qualitative data and the professional panel constructed a scoresheet estimating the Time and Effort required for treatments. Internal consistency and test-retest reliability were adequate. Good convergence was found between the Total Challenge score and Treatment Burden on the CFQ-R (r=-0.49, p = 0.02, n = 31). A recent PA infection signalled higher Total Challenge for caregivers (F(23)11.72, p = 0.002). CONCLUSIONS The CLCF, developed in partnership with parents/caregivers and CF professionals, is a timely, disease-specific burden measure for clinical research.
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Affiliation(s)
- Claire Glasscoe
- Institute of Translational Medicine, Department of Women's & Children's Health, University of Liverpool, Liverpool, UK
| | - Holly F Hope
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | | | | | - Kiri West
- DMOPS (Movement Disorders), Liverpool University Hospitals NHS Foundation Trust (Aintree site), Liverpool, UK
| | - Latifa Patel
- Respiratory Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Tulsi Patel
- Evelina London Children's Hospital, London, UK
| | - Jonathan Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Kevin W Southern
- Institute of Translational Medicine, Department of Women's & Children's Health, University of Liverpool, Liverpool, UK
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Bathgate CJ, Muther E, Georgiopoulos AM, Smith B, Tillman L, Graziano S, Verkleij M, Lomas P, Quittner A. Positive and negative impacts of elexacaftor/tezacaftor/ivacaftor: Healthcare providers' observations across US centers. Pediatr Pulmonol 2023; 58:2469-2477. [PMID: 37265418 DOI: 10.1002/ppul.26527] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Elexacaftor/tezacaftor/ivacaftor (ETI) has been associated with unprecedented clinical improvements, transforming the management of cystic fibrosis (CF). However, side effects with implications for safety and well-being have been reported, including neuropsychiatric changes. This study aimed to better characterize the emerging positive and negative impacts of ETI. METHODS The Cystic Fibrosis Foundation's Mental Health Advisory Committee distributed a 26-item survey to US CF care teams to assess clinician observations of patient-reported experiences with ETI. Survey responses measured the prevalence of these effects in five domains: (1) positive physical and psychological effects, (2) sleep difficulties, (3) cognitive difficulties, (4) worsening mental health, and (5) concerns about the future and finances. RESULTS Seventy-five healthcare providers responded from a pediatric, adult, and combined centers. Positive physical effects of ETI and increased optimism were reported in the upper quartiles (50%-100%) and rated as having a significant impact on daily functioning. Sleep and cognitive difficulties were reported in 1%-24%, with slight impacts on functioning, and psychological symptoms (e.g., increased stress, depression, anxiety) and new psychiatric medications were reported in 1%-24%, with moderate impacts. Concerns about the future were reported in 1%-24%, with minimal impacts. CONCLUSION Across US centers, providers most often observed positive physical effects of ETI. However, a variety of negative side effects were also reported, including sleep disruptions and worsening psychological functioning, which should be systematically monitored by CF teams. These national-level data are a first step in evaluating the prevalence and consequences of these side effects and can directly inform future studies.
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Affiliation(s)
| | - Emily Muther
- Department of Psychiatry and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anna M Georgiopoulos
- Department of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beth Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo-Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | | | - Sonia Graziano
- Department of Pediatrics, Unit of Cystic Fibrosis, Bambino Gesù Children's Hospital, Rome, Italy
| | - Marieke Verkleij
- Department of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paula Lomas
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Alexandra Quittner
- Joe DiMaggio Cystic Fibrosis Pulmonary and Sleep Center, Hollywood, Florida, USA
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Walicka-Serzysko K, Postek M, Borawska-Kowalczyk U, Milczewska J, Sands D. Pulmonary Function Tests in the Evaluation of Early Lung Disease in Cystic Fibrosis. J Clin Med 2023; 12:4735. [PMID: 37510850 PMCID: PMC10380830 DOI: 10.3390/jcm12144735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Properly evaluating respiratory system dysfunction is essential in children with cystic fibrosis (CF). This prospective study aimed to assess the course of early lung disease based on multiple breath nitrogen washout (MBNW), impulse oscillometry (IOS), and conventional techniques, such as spirometry and body plethysmography. METHODS Over a 2 year recruitment period, subjects with CF aged 7-18 performed pulmonary function tests (PFTs). Moreover, the nutritional and microbiological status, frequency of pulmonary exacerbations (PExs), and patients' health-related quality of life (HRQoL) were assessed. RESULTS The mean age of the children (n = 69) was 14.09 ± 3.26 years; F/M 37/32. Spirometry-based diagnoses of normal lung function (forced expiratory volume in 1 s, FEV1 ≥ 90%pred), mild (FEV1 70-89%pred) and moderate (FEV1 40-69%pred) lung diseases were established in 34 (49.3%), 25 (36.2%), and 10 (14.5%) patients, respectively. An elevated lung clearance index (LCI > 6.98) was observed in 85% of the subjects with normal FEV1. The presence of Pseudomonas aeruginosa infection (n = 16) and the number of PExs treated with IV antibiotics were associated with significantly worse PFT results. CONCLUSIONS MBNW and IOS are more helpful tools than conventional techniques in assessing early lung disease in CF. LCI is a more useful parameter for detecting functional abnormalities than FEV1 in school-age children.
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Affiliation(s)
- Katarzyna Walicka-Serzysko
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
- Cystic Fibrosis Centre, Paediatric Hospital, Dziekanow Lesny, 05-092 Łomianki, Poland
| | - Magdalena Postek
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
- Cystic Fibrosis Centre, Paediatric Hospital, Dziekanow Lesny, 05-092 Łomianki, Poland
| | - Urszula Borawska-Kowalczyk
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
- Cystic Fibrosis Centre, Paediatric Hospital, Dziekanow Lesny, 05-092 Łomianki, Poland
| | - Justyna Milczewska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
- Cystic Fibrosis Centre, Paediatric Hospital, Dziekanow Lesny, 05-092 Łomianki, Poland
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
- Cystic Fibrosis Centre, Paediatric Hospital, Dziekanow Lesny, 05-092 Łomianki, Poland
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Mayer-Hamblett N, Ratjen F, Russell R, Donaldson SH, Riekert KA, Sawicki GS, Odem-Davis K, Young JK, Rosenbluth D, Taylor-Cousar JL, Goss CH, Retsch-Bogart G, Clancy JP, Genatossio A, O'Sullivan BP, Berlinski A, Millard SL, Omlor G, Wyatt CA, Moffett K, Nichols DP, Gifford AH, Kloster M, Weaver K, Chapdu C, Xie J, Skalland M, Romasco M, Heltshe S, Simon N, VanDalfsen J, Mead A, Buckingham R, Seidel K, Midamba N, Couture L, Case BZ, Au W, Rockers E, Cooke D, Olander A, Bondick I, Johnson M, VanHousen L, Nicholson B, Omlor G, Parrish M, Roberts D, Head J, Carey J, Caverly L, Dangerfield J, Linnemann R, Fullmer J, Roman C, Mogayzel P, Reyes D, Harmala A, Lysinger J, Bergeron J, Virella-Lowell I, Brown P, Godusevic L, Casey A, Paquette L, Lahiri T, Sweet J, Donaldson S, Harris J, Parnell S, Szentpetery S, Froh D, Tharrington E, Jain M, Nelson R, Kadon S, McPhail G, McBennett K, Rone T, Dasenbrook E, Weaver D, Johnson T, McCoy K, Jain R, Mcleod M, Klosterman M, Sharma P, Jones A, Mueller G, Janney R, Taylor-Cousar J, Cross M, Hoppe J, Cahill J, Mukadam Z, Finto J, Schultz K, Villalta SD, Smith A, Millard S, Symington T, Graff G, Kitch D, Sanders D, Thompson M, Pena T, Teresi M, Gafford J, Schaeffer D, Mermis J, Scott L, Escobar H, Williams K, Dorman D, O'Sullivan B, Bethay R, Danov Z, Berlinski A, Turbeville K, Johannes J, Rodriguez A, Marra B, Zanni R, Morton R, Simeon T, Braun A, Dondlinger N, Biller J, Hubertz E, Antos N, Roth L, Billings J, Larson C, Balaji P, McNamara J, Clark T, Moffett K, Griffith R, Martinez N, Hussain S, Malveaux H, Egan M, Guzman C, DeCelie-Germana J, Galvin S, Savant A, Falgout N, Walker P, Demarco T, DiMango E, Ycaza M, Ballo J, Tirakitsoontorn P, Layish D, Serr D, Livingston F, Wooldridge S, Milla C, Spano J, Davis R, Elidemir O, Chittivelu S, Scott A, Alam S, Dorgan D, Butoryak M, Weiner D, Renna H, Wyatt C, Klein B, Stone A, Lessard M, Schechter MS, Johnson B, Scofield S, Liou T, Vroom J, Akong K, Gil M, Betancourt L, Singer J, Ly N, Moreno C, Aitken M, Gambol T, Genatossio A, Gibson R, Lambert A, Milton J, Rosenbluth D, Smith S, Green D, Hodge D, Fortner C, Forell M, Karlnoski R, Patel K, Daines C, Ryan E, Amaro-Galvez R, Dohanich E, Lennox A, Messer Z, Hanes H, Powell K, Polineni D. Discontinuation versus continuation of hypertonic saline or dornase alfa in modulator treated people with cystic fibrosis (SIMPLIFY): results from two parallel, multicentre, open-label, randomised, controlled, non-inferiority trials. THE LANCET. RESPIRATORY MEDICINE 2023; 11:329-340. [PMID: 36343646 PMCID: PMC10065895 DOI: 10.1016/s2213-2600(22)00434-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Reducing treatment burden is a priority for people with cystic fibrosis, whose health has benefited from using new modulators that substantially increase CFTR protein function. The SIMPLIFY study aimed to assess the effects of discontinuing nebulised hypertonic saline or dornase alfa in individuals using the CFTR modulator elexacaftor plus tezacaftor plus ivacaftor (ETI). METHODS The SIMPLIFY study included two parallel, multicentre, open-label, randomised, controlled, non-inferiority trials at 80 participating clinics across the USA in the Cystic Fibrosis Therapeutics Development Network. We included individuals with cystic fibrosis aged 12-17 years with percent predicted FEV1 (ppFEV1) of 70% or more, or those aged 18 years or older with ppFEV1 of 60% or more, if they had been taking ETI and either (or both) mucoactive therapies (≥3% hypertonic saline or dornase alfa) for at least 90 days before screening. Participants on both hypertonic saline and dornase alfa were randomly assigned to one of the two trials, and those on a single therapy were assigned to the applicable trial. All participants were then randomly assigned 1:1 to continue or discontinue therapy for 6 weeks using permuted blocks of varying size, stratified by baseline ppFEV1 (week 0; ≥90% or <90%), single or concurrent use of hypertonic saline and dornase alfa, previous SIMPLIFY study participation (yes or no), and age (≥18 or <18 years). For participants randomly assigned to continue their therapy during a given trial, this therapy was instructed to be taken at least once daily according to each participant's pre-existing, clinically prescribed regimen. Hypertonic saline concentration was required to be at least 3%. The primary objective for each trial was to determine whether discontinuing was non-inferior to continuing, measured by the 6-week change in ppFEV1 in the per-protocol population. We established a non-inferiority margin of -3% for the difference between groups in the 6-week change in ppFEV1. Safety outcomes were analysed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT04378153. FINDINGS From Aug 25, 2020, to May 25, 2022, a total of 672 unique participants were screened for eligibility for one or both trials, resulting in 847 total random assignments across both trials with 594 unique participants. 370 participants were randomly assigned in the hypertonic saline trial and 477 in the dornase alfa trial. Participants across both trials had an average ppFEV1 of 96·9%. Discontinuing treatment was non-inferior to continuing treatment with respect to the absolute 6-week change in ppFEV1 in both the hypertonic saline trial (-0·19% [95% CI -0·85 to 0·48] in the discontinuation group [n=133] vs 0·14% [-0·51 to 0·78] in the continuation group [n=140]; between-group difference -0·32% [-1·25 to 0·60]) and dornase alfa trial (0·18% [-0·38 to 0·74] in the discontinuation group [n=199] vs -0·16% [-0·73 to 0·41] in the continuation group [n=193]; between-group difference 0·35% [-0·45 to 1·14]), with consistent results in the intention-to-treat populations. In the hypertonic saline trial, 64 (35%) of 184 in the discontinuation group versus 44 (24%) of 186 participants in the continuation group and, in the dornase alfa trial, 89 (37%) of 240 in the discontinuation group versus 55 (23%) of 237 in the continuation group had at least one adverse event. INTERPRETATION In individuals with cystic fibrosis on ETI with relatively well preserved pulmonary function, discontinuing daily hypertonic saline or dornase alfa for 6 weeks did not result in clinically meaningful differences in pulmonary function when compared with continuing treatment.
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Acaster S, Mukuria C, Rowen D, Brazier JE, Wainwright CE, Quon BS, Duckers J, Quittner AL, Lou Y, Sosnay PR, McGarry LJ. Development of the Cystic Fibrosis Questionnaire-Revised-8 Dimensions: Estimating Utilities From the Cystic Fibrosis Questionnaire-Revised. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:567-578. [PMID: 36509366 DOI: 10.1016/j.jval.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; nevertheless, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease-specific, preference-based utility measure based on the adolescent/adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific, patient-reported measure of HRQOL. METHODS Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (eg, factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utilities were used to estimate a preference-based scoring algorithm by regression analysis (tobit models with robust standard errors clustered on participants with censoring at -1). RESULTS A classification system with 8 dimensions (CFQ-R-8 dimensions; physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among the regression models evaluated, the tobit heteroscedastic-ordered model was preferred, with a predicted utility range from 0.236 to 1, no logical inconsistencies, and a mean absolute error of 0.032. CONCLUSION The CFQ-R-8 dimensions is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R.
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Affiliation(s)
| | - Clara Mukuria
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Donna Rowen
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - John E Brazier
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, England, UK
| | - Claire E Wainwright
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Bradley S Quon
- Centre for Heart Lung Innovation, St. Paul's Hospital, and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jamie Duckers
- Department of Respiratory Medicine, Cardiff and Vale University Health Board, NHS Wales, Cardiff, Wales, UK
| | | | - Yiyue Lou
- Biostatistics, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Patrick R Sosnay
- Clincal Development, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Lisa J McGarry
- Health Economics and Outcomes Research, Vertex Pharmaceuticals Incorporated, Boston, MA, USA
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9
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Salah S, Rumman N, Nassar A, Khdour M, Hallak H. Clinical characteristics and outcomes of cystic fibrosis in Palestine: Cross sectional study. Pediatr Pulmonol 2023; 58:1574-1581. [PMID: 36815504 DOI: 10.1002/ppul.26366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To assess the clinical characteristics and outcomes of cystic fibrosis in Palestine by studying the quality of life (QoL) of participants. METHOD This cross-sectional study involved the application of Cystic Fibrosis Questionnaire-Revised (CFQ-R) to participants attending the pediatric pulmonology clinic at Caritas Baby Hospital between January and May 2017. Health status was assessed by measuring pulmonary function test (FEV1 ), body mass index (BMI), age of CF diagnosis, and presence of other affected siblings or deaths in the family. RESULTS There were 77 participants from 58 families: 46.8% (36/77) were males, and 53.3% (41/77) were females. The mean age was 10.7 years (range: 0.5-36 years). The participants were divided into three groups by age in years: group I ( < 6), II (6-13), and III (≥ 14). The highest and lowest CFQ scores were for the eating domain in group III (55.6 ± 22.5) and the body domain in group II (14.5 ± 17.7), respectively. Mean illness severity was 69.6% (range: 33%-111%). The mean BMI was 15.9 (range: 9.6-23.1). The mean age at the time of diagnosis was 4.2 years (± 6.3). The study showed that 1.7% of the families (1/58) had four affected siblings, and 21% (12/58) had death cases related to CF, of which 58.3% (7/12) were from the Hebron district. Finally, all parameters for CF participants in West Bank, Palestine were noticeably lower than those reported in other countries. CONCLUSIONS This study illustrates the need for new therapies for CF participants in Palestine to improve QoL, health status, and longevity.
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Affiliation(s)
- Samya Salah
- Faculty of Pharmacy, Al-Quds University, Abu Deis, Palestine
| | - Nisreen Rumman
- Pediatric Department, Makassed Hospital, East Jerusalem, Palestine
| | | | - Maher Khdour
- Faculty of Pharmacy, Al-Quds University, Abu Deis, Palestine
| | - Hussein Hallak
- Faculty of Medicine, Al-Quds University, Abu Deis, Palestine
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10
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Piehler L, Thalemann R, Lehmann C, Thee S, Röhmel J, Syunyaeva Z, Stahl M, Mall MA, Graeber SY. Effects of elexacaftor/tezacaftor/ivacaftor therapy on mental health of patients with cystic fibrosis. Front Pharmacol 2023; 14:1179208. [PMID: 37153809 PMCID: PMC10160464 DOI: 10.3389/fphar.2023.1179208] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
Introduction: The CFTR modulator drug elexacaftor/tezacaftor/ivacaftor (ETI) was shown to improve CFTR function and clinical symptoms in patients with cystic fibrosis (CF) with at least one F508del allele. Recently, some case reports suggested potential side effects of ETI on mental health with an increase in depressive symptoms and even suicide attempts in patients with CF. However, the general effects of this triple combination therapy on the mental health status of patients with CF remain largely unknown. Methods: We, therefore, performed a prospective, observational study in a real-life setting and investigated the relationship between initiation of ETI therapy and changes in mental health in adult patients with CF. We assessed Cystic Fibrosis Questionnaire-Revised (CFQ-R), Patient Health Questionnaire-9 (PHQ-9), Beck's Depression Inventory - Fast Screen (BDI-FS) and Generalized Anxiety Disorder 7-item Scale (GAD-7) at baseline and 8-16 weeks after initiation of ETI. Results: In total, 70 adult patients with CF with at least one F508del allele and a median age of 27.9 years were recruited. After initiation of ETI, the CFQ-R respiratory domain score improved by 27.9 (IQR 5.6 to 47.2; p < 0.001). The PHQ-9 score of depressive symptoms decreased by 1.0 (IQR -3.0 to 0.3; p < 0.05) with an increase of 16.9% in the group with a minimal score after initiation of ETI and a decrease in the groups of mild (-11.3%) or moderate (-5.7%) scores compared to baseline. The BDI-FS score of depressive symptoms decreased from 1.0 (IQR 0.0-2.0) at baseline to 0.0 (IQR 0.0 to 2.0; p < 0.05) after initiation of ETI. The group with a minimal BDI-FS score increased by 8.0% after initiation of ETI, whereas the groups with mild (-4.9%), moderate (-1.6%) or severe (-1.6%) scores decreased compared to baseline. The GAD-7 score of anxiety symptoms did not change after initiation of ETI compared to baseline (0.0; IQR -2.0. to 0.0; p = 0.112). Conclusion: Initiation of ETI improves symptoms of depression in adult patients with CF with at least one F508del allele. However, symptoms of anxiety do not change after short-term therapy with ETI.
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Affiliation(s)
- Linus Piehler
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ralf Thalemann
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine Lehmann
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité, Charité—Universitätsmedizin, Berlin, Germany
| | - Jobst Röhmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité, Charité—Universitätsmedizin, Berlin, Germany
| | - Zulfiya Syunyaeva
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité, Charité—Universitätsmedizin, Berlin, Germany
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité, Charité—Universitätsmedizin, Berlin, Germany
| | - Simon Y. Graeber
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated partner site, Berlin, Germany
- Berlin Institute of Health at Charité, Charité—Universitätsmedizin, Berlin, Germany
- *Correspondence: Simon Y. Graeber,
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11
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Britto CJ, Ratjen F, Clancy JP. Emerging Approaches to Monitor and Modify Care in the Era of Cystic Fibrosis Transmembrane Conductance Regulators. Clin Chest Med 2022; 43:631-646. [PMID: 36344071 DOI: 10.1016/j.ccm.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As we characterize the clinical benefits of highly effective modulator therapy (HEMT) in the cystic fibrosis (CF) population, our paradigm for treating and monitoring disease continues to evolve. More sensitive approaches are necessary to detect early disease and clinical progression. This article reviews evolving strategies to assess disease control and progression in the HEMT era. This article also explores developments in pulmonary function monitoring, advanced respiratory imaging, tools for the collection of patient-reported outcomes, and their application to profile individual responses, guide therapeutic decisions, and improve the quality of life of people with CF.
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Affiliation(s)
- Clemente J Britto
- Yale Adult Cystic Fibrosis Program, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine.
| | - Felix Ratjen
- Division of Respiratory Medicine, Translational Medicine, University of Toronto Hospital for Sick Children, 555 University Avenue, Toronto Ontario M5G 1X8, Canada
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12
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DeFilippo EMM, Talwalkar JS, Harris ZM, Butcher J, Nasr SZ. Transitions of Care in Cystic Fibrosis. Clin Chest Med 2022; 43:757-771. [PMID: 36344079 DOI: 10.1016/j.ccm.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of formal transition models emerged to reduce variability in care, including cystic fibrosis (CF) responsibility, independence, self-care, and education (RISE), which provides a standardized transition program, including knowledge assessments, self-management checklists, and milestones for people with CF. Despite these interventions, the current landscape of health care transition (HCT) remains suboptimal, and additional focused attention on HCT is necessary. Standardization of assessment tools to gauge the efficacy of transfer from pediatric to adult care is a high priority. Such tools should incorporate both clinical and patient-centered outcomes to provide a comprehensive picture of progress and deficiencies of the HCT process.
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Affiliation(s)
| | - Jaideep S Talwalkar
- Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT, USA; Yale Adult Cystic Fibrosis Program, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zachary M Harris
- Yale Adult Cystic Fibrosis Program, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Butcher
- Department of Pediatrics, Division of Pediatric Psychology, Mott Children's Hospital, University of Michigan Health, Ann Arbor, MI, USA
| | - Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, Mott Children's Hospital, University of Michigan Health, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-5212, USA.
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13
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Schwarzenberg SJ, Palermo JJ, Ye W, Huang S, Magee JC, Alazraki A, Jay Freeman A, Harned R, Karmazyn B, Karnsakul W, Leung DH, Ling SC, Masand P, Molleston JP, Murray KF, Navarro OM, Nicholas JL, Otto RK, Paranjape SM, Siegel MJ, Stoll J, Towbin AJ, Narkewicz MR, Alonso EM. Health-related Quality of Life in a Prospective Study of Ultrasound to Detect Cystic Fibrosis-related Liver Disease in Children. J Pediatr Gastroenterol Nutr 2022; 75:635-642. [PMID: 36070552 PMCID: PMC9624376 DOI: 10.1097/mpg.0000000000003605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Cystic fibrosis liver disease (CFLD) begins early in life. Symptoms may be vague, mild, or nonexistent. Progressive liver injury may be associated with decrements in patient health before liver disease is clinically apparent. We examined Health-Related Quality of Life (HRQOL) in children enrolled in a multi-center study of CFLD to determine the impact of early CFLD on general and disease-specific QOL. METHODS Ultrasound (US) patterns of normal (NL), heterogeneous (HTG), homogeneous (HMG), or nodular (NOD) were assigned in a prospective manner to predict those at risk for advanced CFLD. Parents were informed of results. We assessed parent/child-reported (age ≥5 years) HRQOL by PedsQL 4.0 Generic Core and CF Questionnaire-revised (CFQ-R) prior to US and annually. HRQOL scores were compared by US pattern at baseline (prior to US), between baseline and 1 year and at 5 years. Multivariate analysis of variance (MANOVA) with Hotelling-Lawley trace tested for differences among US groups. RESULTS Prior to US, among 515 participants and their parents there was no evidence that HTG or NOD US was associated with reduced PedsQL/CFQ-R at baseline. Parents of NOD reported no change in PedsQL/CFQ-R over the next year. Child-report PedsQL/CFQ-R (95 NL, 20 NOD) showed improvement between baseline and year 5 for many scales, including Physical Function. Parents of HMG children reported improved CFQ-R scores related to weight. CONCLUSIONS Early undiagnosed or pre-symptomatic liver disease had no impact on generic or disease-specific HRQoL, and HRQoL was remarkably stable in children with CF regardless of liver involvement.
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Affiliation(s)
- Sarah Jane Schwarzenberg
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN
| | - Joseph J. Palermo
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Wen Ye
- Department of Biostatistics, University of Michigan Medical School, Ann Arbor, MI
| | - Suiyuan Huang
- Department of Biostatistics, University of Michigan Medical School, Ann Arbor, MI
| | - John C. Magee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Adina Alazraki
- Department of Radiology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Egleston, Atlanta, GA
| | - A. Jay Freeman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Roger Harned
- Division of Pediatric Radiology, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
| | - Boaz Karmazyn
- Pediatric Radiology, Riley Hospital for Children, Indianapolis, IN
| | - Wikrom Karnsakul
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, John Hopkins School of Medicine, Baltimore, MD
| | - Daniel H. Leung
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children’s Hospital, Houston TX
| | - Simon C. Ling
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Prakash Masand
- Division Radiology, Texas Children’s Hospital, Houston TX
| | - Jean P. Molleston
- Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Karen F. Murray
- Pediatric Institute, Cleveland Clinic and Cleveland Clinic Children’s, Cleveland, OH
| | - Oscar M. Navarro
- Department of Medical Imaging, University of Toronto and Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L. Nicholas
- Division of Pediatric Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Randolph K. Otto
- Department of Radiology, Seattle Children’s Hospital, Seattle, WA
| | - Shruti M. Paranjape
- Division of Pediatric Pulmonology, John Hopkins School of Medicine, Baltimore, MD
| | - Marilyn J. Siegel
- Division of Pediatric Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Janis Stoll
- Division of Gastroenterology and Nutrition, Washington University School of Medicine, St Louis, MO
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael R. Narkewicz
- Digestive Health Institute, Children’s Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Estella M. Alonso
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL
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14
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Finlay C, Patel S, Evans J. Assessing Psychosocial Distress in Cystic Fibrosis: Validation of the 'Distress in Cystic Fibrosis Scale'. J Clin Psychol Med Settings 2022; 29:699-708. [PMID: 34586547 PMCID: PMC8479494 DOI: 10.1007/s10880-021-09825-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/30/2022]
Abstract
Experiences of anxiety and depression are common in adults with Cystic Fibrosis (AwCF) (e.g. Quittner in Thorax 69:1090-1097, 2014) and may impact on a wide range of important health-related behaviours, such as adherence to medication and timely attendance for medical review when experiencing pulmonary exacerbation. Common screening measures used in CF such as the PHQ-9 and GAD-7 may reflect an absence of anxiety or depression when clinically significant emotional difficulties are apparent on further assessment. This study preliminarily validated the previously developed Distress in Cystic Fibrosis Scale (DCFS) (Patel in Journal of Cystic Fibrosis 15:S26, 2016); a 23-item questionnaire to assess psychosocial distress in AwCF. Inpatient and outpatient participants with CF (N = 119) completed a battery of questionnaires, including the DCFS. PCA results supported a single component model. The DCFS showed high internal consistency and correlated significantly with measures of mood and quality of life. The DCFS shows promise as a screening tool to assess clinically significant psychosocial distress in an adult CF population.
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Affiliation(s)
- Caroline Finlay
- Acute Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK.
- Pain Management Psychology, Victoria Infirmary, 55 Grange Road, Glasgow, G42 9LF, UK.
| | - Sejal Patel
- Acute Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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15
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Perrem L, Stanojevic S, Shaw M, Pornillos M, Guido J, Sanders DB, Solomon M, Grasemann H, Sweezey N, Waters V, Davis SD, Ratjen F. Comparative analysis of respiratory symptom scores to detect acute respiratory events in children with cystic fibrosis. J Cyst Fibros 2022; 22:296-305. [PMID: 35753986 DOI: 10.1016/j.jcf.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are important outcome measures in research and clinical practice. This study describes the longitudinal variability the Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory score and the Chronic Respiratory Infection Symptom Score (CRISS), as well as their ability to identify acute respiratory events in children with CF. METHODS In this prospective observational study, the parent-proxy (6 -13 years) and self-reported (6-18 years) CFQ-R Respiratory score and CRISS (6-18 years) were measured every 3 months over 2 years. The lung clearance index (LCI) and FEV1 were also measured. We compared the diagnostic accuracy of the PROs in distinguishing acute respiratory events and clinically stable visits, using the minimal important difference of each PRO as the threshold. RESULTS A total of 98 children with CF were included. On average, the symptom scores did not change between clinically stable visits. The positive predictive value (PPV) and negative predictive value (NPV) of a ≥8.5-point worsening in the parent-proxy CFQ-R score to identify acute respiratory events (n=119) (PPV 70.2% and NPV 87.0%) were higher than for the self-reported CFQ-R score (PPV 58.9% and NPV 72.2%). The PPV and NPV of an ≥11-point change in the CRISS for acute respiratory events (n=137) was 56.5% and 79.6%, respectively. The PPV and NPV of all PROs were increased when combined with the LCI and/or FEV1pp. CONCLUSION Symptoms scores differ in their ability to identify acute respiratory events in children with CF; PPV and NPV of all PROs were improved when combined with lung function outcomes.
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Affiliation(s)
- Lucy Perrem
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada; Royal College of Surgeons in Ireland, Dublin, Ireland; National Children's Research Centre, Children's Health Ireland, Dublin 5, Ireland.
| | - Sanja Stanojevic
- Institute of Health Policy Management and Evaluation, University of Toronto, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Michelle Shaw
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Maryjess Pornillos
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Julia Guido
- Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Don B Sanders
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Melinda Solomon
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Neil Sweezey
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
| | - Valerie Waters
- Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada; Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Canada
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Felix Ratjen
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Canada; Translational Medicine Program, SickKids Research Institute, Toronto, Canada
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16
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Bourne K, Croston M. Resurrecting the 'fourth 90': towards a definition of health-related quality of life in HIV care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S23-S27. [PMID: 35678815 DOI: 10.12968/bjon.2022.31.11.s23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medical advancements in the treatment of HIV continue to return ever more impressive medical results; increasing life expectancy and reducing negative symptoms (either disease-related or medically-induced). Physical wellness, however, is only one of the many facets of human life. It has been 5 years since Lazarus et al proposed we should be looking towards a fourth 90-good health-related quality of life (QoL)-yet little has been done to take up this task within a coherent approach. We suggest that one of the barriers to this is a lack of definition about what we mean by 'good health-related quality of life' (HRQoL) for people living with HIV. This article considers existing definitions of this, and related terms, and the difficulties in finding a universal definition. It goes on to suggest a way to a conceptual HRQoL in people living with HIV based on the biopsychosocial model. It is proposed that by doing it this way, practitioners can assess HRQoL in a comprehensive way, and focus on the things that matter to the individual.
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Affiliation(s)
- Kathryn Bourne
- Clinical Psychologist, Department of Infectious Diseases, Manchester University NHS Foundation Trust/Division of Health Researcher, Faculty of Health and Medicine, Lancaster University
| | - Michelle Croston
- Associate Professor of Nursing, School of Health Sciences, University of Nottingham, Nottingham
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17
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Nichols DP, Singh PK, Baines A, Caverly LJ, Chmiel JF, GIbson RL, Lascano J, Morgan SJ, Retsch-Bogart G, Saiman L, Sadeghi H, Billings JL, Heltshe SL, Kirby S, Kong A, Nick JA, Mayer-Hamblett N. Testing the effects of combining azithromycin with inhaled tobramycin for P. aeruginosa in cystic fibrosis: a randomised, controlled clinical trial. Thorax 2022; 77:581-588. [PMID: 34706982 PMCID: PMC9043040 DOI: 10.1136/thoraxjnl-2021-217782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Inhaled tobramycin and oral azithromycin are common chronic therapies in people with cystic fibrosis and Pseudomonas aeruginosa airway infection. Some studies have shown that azithromycin can reduce the ability of tobramycin to kill P. aeruginosa. This trial was done to test the effects of combining azithromycin with inhaled tobramycin on clinical and microbiological outcomes in people already using inhaled tobramycin. We theorised that those randomised to placebo (no azithromycin) would have greater improvement in forced expiratory volume in one second (FEV1) and greater reduction in P. aeruginosa sputum in response to tobramycin. METHODS A 6-week prospective, randomised, placebo-controlled, double-blind trial testing oral azithromycin versus placebo combined with clinically prescribed inhaled tobramycin in individuals with cystic fibrosis and P. aeruginosa airway infection. RESULTS Over a 6-week period, including 4 weeks of inhaled tobramycin, the relative change in FEV1 did not statistically significantly differ between groups (azithromycin (n=56) minus placebo (n=52) difference: 3.44%; 95% CI: -0.48 to 7.35; p=0.085). Differences in secondary clinical outcomes, including patient-reported symptom scores, weight and need for additional antibiotics, did not significantly differ. Among the 29 azithromycin and 35 placebo participants providing paired sputum samples, the 6-week change in P. aeruginosa density differed in favour of the placebo group (difference: 0.75 log10 CFU/mL; 95% CI: 0.03 to 1.47; p=0.043). CONCLUSIONS Despite having greater reduction in P. aeruginosa density in participants able to provide sputum samples, participants randomised to placebo with inhaled tobramycin did not experience significantly greater improvements in lung function or other clinical outcomes compared with those randomised to azithromycin with tobramycin.
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Affiliation(s)
- David P Nichols
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Centre, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Pradeep K Singh
- Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - Arthur Baines
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Centre, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Lindsay J Caverly
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James F Chmiel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ronald L GIbson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jorge Lascano
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Florida Health, Gainesville, Florida, USA
| | - Sarah J Morgan
- Department of Microbiology, University of Washington, Seattle, Washington, USA
| | - George Retsch-Bogart
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Hossein Sadeghi
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Joanne L Billings
- Department of Medicine, Pulmonary, Allergy and Critical Care Division, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Sonya L Heltshe
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Centre, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
| | - Shannon Kirby
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Centre, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Ada Kong
- Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jerry A Nick
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Nicole Mayer-Hamblett
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Centre, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, USA
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18
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Lee DJ, Sykes J, Griffin K, Noel CW, Hyung B, Chokar K, Yao CM, Tullis E, Lee JM. The negative impact of chronic rhinosinusitis on the health-related quality of life among adult patients with cystic fibrosis. J Cyst Fibros 2022; 21:800-806. [PMID: 35660273 DOI: 10.1016/j.jcf.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND With improved survival in cystic fibrosis (CF) patients, it is crucial to evaluate the impact of chronic co-morbidities such as chronic rhinosinusitis (CRS). The objectives were 1) To determine the prevalence of CRS with a large series of CF patients 2) To evaluate the impact of CRS on the Health-Related Quality of Life (HRQoL) of CF patients and 3) To compare CRS-specific, CF-specific and general HRQoL instruments. METHODS Consecutive CF patients from the Toronto Adult Cystic Fibrosis Centre were recruited between March 2018 and January 2020. Participants completed the 22-Item Nasal Outcome Test (SNOT-22), Cystic Fibrosis Questionnaire-Revised for adolescents and adults over 14 years of age (CFQ-R), Cystic Fibrosis Quality of Life Evaluative Self-administered Test (CF-QUEST) and the 36-Item Short Form Survey (SF-36). HRQoL scores were correlated using Spearman's correlation coefficients. RESULTS Out of 195 patients eligible for analysis, the prevalence of CRS with positive endoscopic findings was 42.6% (95% confidence interval: 35.5-49.8%). CRS patients reported significantly lower HRQoL with higher SNOT-22 scores and lower scores in the respiratory domain of CFQ-R and physical health domains of CF-QUEST and SF-36. The physical (ρ= -0.63) and mental (ρ= -0.66) domains of SF-36 and CF-QUEST (ρ= -0.76) had a strong correlation with SNOT-22. Higher scores of SNOT-22 nasal subdomains correlated with lower scores of SF-36, CFQ-R and CF-QUEST. CONCLUSION CRS is a prevalent co-morbidity of CF patients, which significantly reduces HRQoL. SNOT-22, CFQ-R, CF-QUEST and SF-36 were strongly correlated. Severity of sinonasal symptoms have a strong correlation with HRQoL in CF patients.
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Sykes
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Katherine Griffin
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian Hyung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kamalprit Chokar
- Adult Cystic Fibrosis Centre, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Christopher Mkl Yao
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Tullis
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John M Lee
- Department of Otolaryngology-Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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19
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Anderson JL, Tierney AC, Miles C, Kotsimbos T, King SJ. PROBIOTIC USE IN ADULTS WITH CYSTIC FIBROSIS IS COMMON AND INFLUENCED BY GASTROINTESTINAL HEALTH NEEDS: A CROSS SECTIONAL SURVEY STUDY. J Hum Nutr Diet 2022; 35:444-454. [DOI: 10.1111/jhn.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jacqueline L Anderson
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
| | - Audrey C Tierney
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute University of Limerick Limerick Ireland
| | - Caitlin Miles
- Nutrition and Dietetics Department, Monash Health Clayton Victoria Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Department of Medicine Monash University Melbourne Australia
| | - Susannah J King
- Department of Dietetics, Nutrition and Sport, School of Allied Health La Trobe University Victoria Australia
- Cystic Fibrosis Service, Department of Allergy, Immunology and Respiratory Medicine, Alfred Health Melbourne Victoria Australia
- Nutrition Department Alfred Health Melbourne Victoria Australia
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20
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Evaluating the alginate oligosaccharide (OligoG) as a therapy for Burkholderia cepacia complex cystic fibrosis lung infection. J Cyst Fibros 2022; 21:821-829. [DOI: 10.1016/j.jcf.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/15/2021] [Accepted: 01/09/2022] [Indexed: 11/15/2022]
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21
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Mason KA, Marks BE, Wood CL, Le TN. Cystic fibrosis-related diabetes: The patient perspective. J Clin Transl Endocrinol 2021; 26:100279. [PMID: 34926167 PMCID: PMC8649788 DOI: 10.1016/j.jcte.2021.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) affects nearly 20% of adolescents and 40-50% of adults. However, the impact on patients and their families is poorly understood. Here, we examine how patients perceive CFRD and identify gaps in our understanding of the patient experience. Despite its relatively high prevalence, data suggest that many individuals are not aware of the possibility of developing CFRD or compare it to other types of diabetes. Annual oral glucose tolerance testing (OGTT) may serve as an opportunity to provide education and prepare individuals for the possibility of developing abnormalities in glucose tolerance. Many cite lack of awareness of CFRD as the most difficult part of the diagnosis. While factors such as older age and a strong support system promote acceptance, most individuals view the diagnosis negatively and struggle to balance the demands of diabetes with other obligations, including airway clearance, nebulizer therapies, supplementation nutrition, and administration of vitamins and medications. Relatively few people with CFRD monitor their blood glucoses consistently, which is attributed to time constraints or an attempt to avoid pain. In addition, many feel that they are not prone to hypoglycemia and are not concerned with long-term complications, anticipating that they will succumb to their pulmonary disease before these become problematic. The adolescent period presents unique challenges for adherence as children work to develop autonomy. Factors that promote CFRD adherence include incorporating management into daily CF routines and the support of knowledgeable providers to help develop an individualized approach to management. Diabetes technology has the potential to reduce treatment burden and improve glycemic control, but data in CFRD are limited, and additional study is needed. Given that CFRD is associated with a decline in health-related quality of life, it is critical that providers understand patients' perspectives and address gaps in understanding and barriers to management.
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Affiliation(s)
- Kelly A. Mason
- University of Virginia, Department of Pediatric Endocrinology, PO Box 800386, Charlottesville, VA 22908, USA
| | - Brynn E. Marks
- Children’s National Hospital, Division of Endocrinology and Diabetes, 111 Michigan Avenue NW, Washington District of Columbia 20010, USA
- George Washington University School of Medicine & Health Sciences, Department of Pediatrics, Ross Hall, 2300 Eye Street, NW, Washington DC 20037, USA
| | - Colleen L. Wood
- Billings Clinic, Pediatric Subspecialties Department, Pediatric Diabetes and Endocrinology, 2800 Tenth Avenue North P.O. Box 37000, Billings, MT 59107, USA
| | - Trang N. Le
- Virginia Commonwealth University, Department of Internal Medicine and Pediatrics, Division of Pediatric Endocrinology, Diabetes, and Metabolism, 2305 N. Parham Road Suite 1, Richmond, VA 23229, USA
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22
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Leso V, Carnovale V, Iacotucci P, Pacella D, Romano R, Della Volpe I, Iavicoli I. Employment Status and Work Ability in Adults with Cystic Fibrosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211776. [PMID: 34831532 PMCID: PMC8623674 DOI: 10.3390/ijerph182211776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
Improvements in the survival and clinical outcomes of cystic fibrosis (CF) patients raised questions about their workforce participation and capacity to work. One hundred and ninety-six outpatients, attending the Adult CF Center of an Italian University Hospital, were enrolled between May 2020 and March 2021. The patients’ personal and clinical characteristics, employment status, and profession were assessed. The Cystic Fibrosis Questionnaire—Revised and the work ability index (WAI) were employed to assess CF health-related quality of life and the employee’s perception of their ability to work, respectively. Among the enrolled patients, 98 (50%) were employed. The non-working subjects were significantly younger (mean age ± standard deviation: 30 ± 10 vs. 37 ± 10 years) and were diagnosed with CF significantly earlier (9 ± 13 vs. 17 ± 18 years) than the employed subjects. The vast majority of CF workers (82.6%) were employed in tertiary professions. A general good work ability perception was determined in the employed population. Aging and being employed for >15 years could significantly predict a reduction in work ability, while a better quality of life was a positive predictor for its enhancement. Although further research is necessary, these results may introduce interdisciplinary CF healthcare management that includes a work function assessment, formal career counseling, and job guidance to support the personal, social and professional lives of CF patients.
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Affiliation(s)
- Veruscka Leso
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (R.R.); (I.D.V.)
| | - Vincenzo Carnovale
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.C.); (P.I.)
| | - Paola Iacotucci
- Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.C.); (P.I.)
| | - Daniela Pacella
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy;
| | - Rosaria Romano
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (R.R.); (I.D.V.)
| | - Ilaria Della Volpe
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (R.R.); (I.D.V.)
| | - Ivo Iavicoli
- Section of Occupational Medicine, Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (R.R.); (I.D.V.)
- Correspondence: ; Tel.: +39-0817462430; Fax: +39-0817462124
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23
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Bernstein R, Lynn C, Faro A, Barker D, Quittner A. Pretransplant Quality of Life and Post-Transplant Survival in Adolescents with Cystic Fibrosis. J Pediatr Psychol 2021; 47:350-359. [PMID: 34718670 DOI: 10.1093/jpepsy/jsab105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Cystic fibrosis (CF) is the most common indication for pediatric lung transplantation and the third most common for adults. The selection of candidates and timing of transplant is challenging and whether there is a survival benefit of this procedure for pediatric patients is controversial. Use of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a well-validated, disease-specific quality of life measure may improve pretransplant referral decision-making. METHODS This multicenter study evaluated whether specific domains on the CFQ-R (i.e., Physical Functioning, Respiratory Symptoms), assessed pretransplant, predicted survival 4-year post-transplant (n = 25). A two-step Cox regression, with physical predictors entered in step one (i.e., age, CF-related Diabetes, FEV1% predicted) and the Physical Functioning and Respiratory Symptoms CFQ-R scales entered in step two, was used to assess whether the CFQ-R explained additional and unique variance. Receiver Operating Characteristic (ROC) curves were used to assess the sensitivity and specificity of optimal cut-points of significant CFQ-R domains. RESULTS The Respiratory Symptoms scale predicted survival 4-year post-transplant (Exp(B) = 0.38, 95% CI = 0.14-1.01; area under the curve = 0.87) and once it was added to the model, no other individual predictors were significant. The incremental improvement beyond the physical parameters approached but did not reach statistical significance (χ2 Δ = 5.79, p = .06). CONCLUSIONS This study suggested that including patient-reported outcomes could aid pretransplant referral decision-making. The Respiratory Symptoms scale in particular may serve as a useful tool to help determine when to refer and evaluate an individual for transplant.
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Affiliation(s)
- Ruth Bernstein
- Wake Forest Baptist Medical Center, Bariatric and Weight Management, USA.,Department of Psychology, University of Miami, USA
| | - Courtney Lynn
- University of Colorado, School of Medicine, Department of Psychiatry, USA
| | | | - David Barker
- Division of Psychiatry and Human Behavior, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, USA
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24
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Blanco-Orive P, Del Corral T, Martín-Casas P, Ceniza-Bordallo G, López-de-Uralde-Villanueva I. Quality of life and exercise tolerance tools in children/adolescents with cystic fibrosis: Systematic review. Med Clin (Barc) 2021; 158:519-530. [PMID: 34507821 DOI: 10.1016/j.medcli.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This systematic review aims to analyze the validity and reliability of available tools to assess health-related quality of life (HRQoL) and exercise tolerance in children and adolescents with cystic fibrosis (CF). MATERIALS AND METHODS A review of observational studies studying the validity and reliability of the tools was conducted. The COSMIN (COnsesus-based Standards for the selection of health Measurements INstruments) guide was followed to analyze the quality of these tools. RESULTS A total of 18 studies were selected. Of the eight HRQoL tools, five generic and three specific, analyzed in 14 studies, the Cystic Fibrosis Questionnaire-Revised (CFQ-R) presents the best properties. Of the four tools analyzed to assess exercise tolerance, cycle ergometry and the modified shuttle test are the most valid and reliable. CONCLUSIONS The CFQ-R, cycloergometry and the modified shuttle test have the best properties for the assessment of children with CF, but more studies are needed.
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Affiliation(s)
- Paula Blanco-Orive
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Tamara Del Corral
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España.
| | - Guillermo Ceniza-Bordallo
- Programa de doctorado en Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, España
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25
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Alishbayli G, Kilinc AA, Cokugras H. Evaluation of the health-related quality of life in Turkish cystic fibrosis patients. Pediatr Int 2021; 63:965-970. [PMID: 33207026 DOI: 10.1111/ped.14553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prolongation of life expectancy in cystic fibrosis (CF) to the fourth decade makes health-related quality of life (HRQOL) an important issue in this population. This study aims to evaluate the effects of clinical and socio-demographic characteristics of patients on different aspects of HRQOL in a pediatric CF population. We also intend to assess some measures of reliability and validity of the Turkish CF Questionnaire-Revised (CFQ-R) forms. METHODS Fifty-four CF patients and 46 parents / caregivers filled the appropriate CFQ-R forms. Disease severity was evaluated via modified Shwachman-Kulczycki (SK) scores, and additional clinical information was obtained from patient records. RESULTS Forty-three percent (n = 23) of patients were female, the mean age of patients being 13.3 ± 3.96 years. Self- and proxy-reported points showed a strong correlation (Spearman's rho > 0.6) on more observable domains of HRQOL (e.g. physical functioning). No significant difference was found between sexes on any HRQOL domain. When compared between age groups, treatment burden appeared to worsen with age, while social functioning improved. All three forms of the CFQ-R Turkish version showed acceptable internal consistency reliability and convergence with disease severity measures. CONCLUSIONS The CFQ-R showed a fair correlation with the Shwachman-Kulczycki score and the FEV1% value, which makes its longitudinal use possible in clinical practice. It is important to use self-reported evaluations as well as parent / caregiver-reported HRQOL evaluations, especially in young children. More studies are needed to assess the psychometric properties of Turkish CFQ-R forms.
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Affiliation(s)
- Gulzar Alishbayli
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Haluk Cokugras
- Department of Pediatrics, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey.,Department of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul University- Cerrahpasa, Istanbul, Turkey
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26
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Sherman AC, Simonton-Atchley S, O'Brien CE, Campbell D, Reddy RM, Guinee B, Wagner LD, Anderson PJ. Associations Between Religious/Spiritual Coping and Depression Among Adults with Cystic Fibrosis: A 12-Month Longitudinal Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:2646-2661. [PMID: 33575892 DOI: 10.1007/s10943-021-01185-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
Individuals with cystic fibrosis (CF) face a challenging disease, and depression is a significant concern. Many patients draw on religious/spiritual resources to assist them in managing the demands of chronic illness; however, these coping efforts rarely have been evaluated among adults with CF. This longitudinal study examined relationships between distinct types of positive and negative religious/spiritual coping at baseline (assessed with the RCOPE) and depression screening outcomes 12 month later (assessed with the Hospital Anxiety and Depression Scale). In logistic regression analyses controlling for disease severity (FEV1% predicted), lower likelihood of depression caseness at 12 months was predicted by higher general religiousness at baseline, greater use of benevolent religious reappraisal coping, greater use of spiritual connection coping, and lower spiritual discontent. Results suggest that distinct aspects religious/spiritual coping have differential associations with subsequent depression outcomes. Findings extend prior research to an important, understudied medical population, and address a clinically meaningful outcome.
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Affiliation(s)
- Allen C Sherman
- Behavioral Medicine Division, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | - Catherine E O'Brien
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dianne Campbell
- Cystic Fibrosis Clinic, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Social Work, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Raghu M Reddy
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- St. Vincent's Hospital, Little Rock, AR, USA
| | - Bethany Guinee
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Pharmacy Department, Select Specialty Hospital, Orlando, FL, USA
| | - Laura D Wagner
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Primary Care Clinic, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paula J Anderson
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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27
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Evaluating the Impact of Stopping Chronic Therapies after Modulator Drug Therapy in Cystic Fibrosis: The SIMPLIFY Clinical Trial Study Design. Ann Am Thorac Soc 2021; 18:1397-1405. [PMID: 33465316 PMCID: PMC8513667 DOI: 10.1513/annalsats.202010-1336sd] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The care for individuals with cystic fibrosis (CF) with at least one F508del mutation will greatly change as a result of the unparalleled clinical benefits observed with the new triple-combination CFTR (CF transmembrane regulator)-modulator therapy elexacaftor/tezacaftor/ivacaftor (ETI). Incorporating ETI into the standard of care creates new motivation and opportunity to consider reductions in overall treatment burden and evaluate whether other chronic medications can now be safely discontinued without loss of clinical benefit. SIMPLIFY is a master protocol poised to test the impact of discontinuing versus continuing two commonly used chronic therapies in people with CF who are at least 12 years of age or older and stable on ETI therapy. The protocol is composed of two concurrent randomized controlled trials designed to evaluate the independent short-term effects of discontinuing hypertonic saline or dornase alfa, enabling individuals on both therapies to participate in one or both trials. The primary objective for each trial is to determine whether discontinuing treatment is noninferior to continuing treatment after establishment of ETI, as measured by the 6-week absolute change in the percent-predicted forced expiratory volume in 1 second. Developing this study required a balance between ideal study-design principles and feasibility. SIMPLIFY will be the largest multicenter, randomized, controlled medication-withdrawal study in CF. This study is uniquely positioned to provide timely evidence on whether the daily treatment burden can be reduced among individuals on CFTR-modulator therapy. Clinical trial registered with www.clinicaltrials.gov (NCT04378153).
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28
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Simon SL, Ferris KA, Durkin K, Riekert K, Duncan C. Accuracy of Body Size Estimation in Youth with Cystic Fibrosis and Association with Health-Related Quality of Life. J Clin Psychol Med Settings 2021; 27:459-466. [PMID: 31728881 DOI: 10.1007/s10880-019-09677-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accuracy of body size estimation may impact motivation to adhere to treatment recommendations and health-related quality of life (HRQOL) in youth with cystic fibrosis (CF), but this has not yet been investigated. Thus, the goal of the current study was to examine accuracy of body size estimation in youth with CF, and associations with HRQOL, lung functioning, and dietary intake. Fifty-four youth diagnosed with CF (M = 13.61 years) completed the Figure Rating Scale, the Cystic Fibrosis Questionnaire-Revised, and a 24-h diet recall interview. Cohen's Weighted Kappa Coefficient evaluated agreement between body size estimation and BMI percentile. Binary logistic regression analyses examined associations between body size accuracy and HRQOL, lung functioning, and dietary intake. A less than adequate agreement was found between youth body size estimation and BMI percentile. Most participants overestimated body size (69.8%). Body Image HRQOL, but neither lung functioning nor dietary intake, was significantly associated with body size estimation accuracy. Working with patients to improve perceptions of body size may also improve HRQOL scores and allow for discussion about treatment goals related to body size.
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Affiliation(s)
- Stacey L Simon
- Department of Pediatrics, Division of Pulmonary Medicine, University of Colorado Anschutz Medical Campus, and Children's Hospital Colorado, 13123 East 16th Avenue Box B395, Aurora, CO, 80045, USA.
| | - Kaitlyn A Ferris
- Outlier Research & Evaluation, UChicago STEM Education, University of Chicago, Chicago, USA
| | - Kristine Durkin
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Kristin Riekert
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christina Duncan
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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29
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Perrem L, Stanojevic S, Shaw M, Jensen R, McDonald N, Isaac SM, Davis M, Clem C, Guido J, Jara S, France L, Solomon M, Grasemann H, Waters V, Sweezey N, Sanders DB, Davis SD, Ratjen F. Lung Clearance Index to Track Acute Respiratory Events in School-Age Children with Cystic Fibrosis. Am J Respir Crit Care Med 2021; 203:977-986. [PMID: 33030967 DOI: 10.1164/rccm.202006-2433oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Rationale: The lung clearance index (LCI) is responsive to acute respiratory events in preschool children with cystic fibrosis (CF), but its utility to identify and manage these events in school-age children with CF is not well defined.Objectives: To describe changes in LCI with acute respiratory events in school-age children with CF.Methods: In a multisite prospective observational study, the LCI and FEV1 were measured quarterly and during acute respiratory events. Linear regression was used to compare relative changes in LCI and FEV1% predicted at acute respiratory events. Logistic regression was used to compare the odds of a significant worsening in LCI and FEV1% predicted at acute respiratory events. Generalized estimating equation models were used to account for repeated events in the same subject.Measurements and Main Results: A total of 98 children with CF were followed for 2 years. There were 265 acute respiratory events. Relative to a stable baseline measure, LCI (+8.9%; 95% confidence interval, 6.5 to 11.3) and FEV1% predicted (-6.6%; 95% confidence interval, -8.3 to -5.0) worsened with acute respiratory events. A greater proportion of events had a worsening in LCI compared with a decline in FEV1% predicted (41.7% vs. 30.0%; P = 0.012); 53.9% of events were associated with worsening in LCI or FEV1. Neither LCI nor FEV1 recovered to baseline values at the next follow-up visit.Conclusions: In school-age children with CF, the LCI is a sensitive measure to assess lung function worsening with acute respiratory events and incomplete recovery at follow-up. In combination, the LCI and FEV1 capture a higher proportion of events with functional impairment.
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Affiliation(s)
- Lucy Perrem
- Division of Respiratory Medicine and.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada.,Royal College of Surgeons in Ireland, Dublin, Ireland.,National Children's Research Centre, Children's Health Ireland, Dublin, Ireland
| | - Sanja Stanojevic
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Michelle Shaw
- Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Renee Jensen
- Division of Respiratory Medicine and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Nancy McDonald
- Division of Respiratory Medicine and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Sarah M Isaac
- Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Miriam Davis
- Division of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; and
| | - Charles Clem
- Division of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; and
| | - Julia Guido
- Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Sylvia Jara
- Division of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; and
| | - Lisa France
- Division of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; and
| | - Melinda Solomon
- Division of Respiratory Medicine and.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Hartmut Grasemann
- Division of Respiratory Medicine and.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Neil Sweezey
- Division of Respiratory Medicine and.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
| | - Don B Sanders
- Division of Pediatric Pulmonology, Riley Hospital for Children, Indianapolis, Indiana; and
| | - Stephanie D Davis
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Felix Ratjen
- Division of Respiratory Medicine and.,Department of Paediatrics and.,Translational Medicine Program, SickKids Research Institute, Toronto, Ontario, Canada
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Duckers J, Lesher B, Thorat T, Lucas E, McGarry LJ, Chandarana K, De Iorio F. Real-World Outcomes of Ivacaftor Treatment in People with Cystic Fibrosis: A Systematic Review. J Clin Med 2021; 10:1527. [PMID: 33917386 PMCID: PMC8038673 DOI: 10.3390/jcm10071527] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022] Open
Abstract
Cystic fibrosis (CF) is a rare, progressive, multi-organ genetic disease. Ivacaftor, a small-molecule CF transmembrane conductance regulator modulator, was the first medication to treat the underlying cause of CF. Since its approval, real-world clinical experience on the use of ivacaftor has been documented in large registries and smaller studies. Here, we systematically review data from real-world observational studies of ivacaftor treatment in people with CF (pwCF). Searches of MEDLINE and Embase identified 368 publications reporting real-world studies that enrolled six or more pwCF treated with ivacaftor published between January 2012 and September 2019. Overall, 75 publications providing data from 57 unique studies met inclusion criteria and were reviewed. Studies reporting within-group change for pwCF treated with ivacaftor consistently showed improvements in lung function, nutritional parameters, and patient-reported respiratory and sino-nasal symptoms. Benefits were evident as early as 1 month following ivacaftor initiation and were sustained over long-term follow-up. Decreases in pulmonary exacerbations, Pseudomonas aeruginosa prevalence, and healthcare resource utilization also were reported for up to 66 months following ivacaftor initiation. In studies comparing ivacaftor treatment to modulator untreated comparator groups, clinical benefits similarly were reported as were decreases in mortality, organ-transplantation, and CF-related complications. The safety profile of ivacaftor observed in these real-world studies was consistent with the well-established safety profile based on clinical trial data. Our systematic review of real-world studies shows ivacaftor treatment in pwCF results in highly consistent and sustained clinical benefit in both pulmonary and non-pulmonary outcomes across various geographies, study designs, patient characteristics, and follow-up durations, confirming and expanding upon evidence from clinical trials.
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Affiliation(s)
- Jamie Duckers
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff CF64 2XX, UK
| | - Beth Lesher
- Pharmerit—An OPEN Health Company, 4350 East-West Highway, Suite 1100, Bethesda, MD 20814, USA; (B.L.); (E.L.)
| | - Teja Thorat
- Vertex Pharmaceuticals Incorporated, Boston, MA 02210, USA; (T.T.); (L.J.M.); (K.C.)
| | - Eleanor Lucas
- Pharmerit—An OPEN Health Company, 4350 East-West Highway, Suite 1100, Bethesda, MD 20814, USA; (B.L.); (E.L.)
| | - Lisa J. McGarry
- Vertex Pharmaceuticals Incorporated, Boston, MA 02210, USA; (T.T.); (L.J.M.); (K.C.)
| | - Keval Chandarana
- Vertex Pharmaceuticals Incorporated, Boston, MA 02210, USA; (T.T.); (L.J.M.); (K.C.)
| | - Fosca De Iorio
- Vertex Pharmaceuticals (Europe) Limited, London W2 6BD, UK;
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Flume PA, Amelina E, Daines CL, Charlton B, Leadbetter J, Guasconi A, Aitken ML. Efficacy and safety of inhaled dry-powder mannitol in adults with cystic fibrosis: An international, randomized controlled study. J Cyst Fibros 2021; 20:1003-1009. [PMID: 33715994 DOI: 10.1016/j.jcf.2021.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/14/2020] [Accepted: 02/01/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mannitol is a mucoactive hyperosmotic agent used as add-on therapy in patients with cystic fibrosis (CF), administered twice-daily (BID) via a small, portable, breath-actuated dry-powder inhaler. This study was conducted to provide confirmatory evidence of mannitol's efficacy and safety in adults. METHODS This multicenter, double-blind, randomized, parallel-group, controlled clinical trial recruited adults (aged ≥18 years) with CF, and forced expiratory volume in 1 second (FEV1) 40-90% predicted. Subjects received either mannitol 400 mg or mannitol 50 mg (control), BID via dry-powder inhaler for 26 weeks. Primary endpoint: FEV1 averaged over the 26-week treatment period. RESULTS Of 423 subjects randomized (209 or 214 receiving mannitol 400 mg BID or control, respectively), 373 (88.2%) completed the study, with a similar proportion completing in the two groups. For FEV1 averaged over 26 weeks, mannitol 400 mg BID was statistically superior to control (adjusted mean difference 54 mL [95% CI 8, 100 mL]; p = 0.020). This was supported by sensitivity analyses of the primary endpoint, and by observed improvements in secondary pulmonary function endpoints (eg, absolute adjusted mean difference in percent predicted FEV1 averaged over 26 weeks 1.21% [0.07%, 2.36%]; p = 0.037). Adverse events were mainly mild or moderate in severity, with treatment-related adverse events in 15.5 and 12.2% of subjects receiving mannitol 400 mg BID and control, respectively. CONCLUSIONS In adults with CF, mannitol 400 mg BID inhaled as a dry-powder statistically significantly improved lung function (FEV1) compared with control, with this improvement supported by sensitivity analyses and secondary pulmonary function endpoints. Mannitol had a good overall safety and tolerability profile. ClinicalTrials.gov: NCT02134353.
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Affiliation(s)
- Patrick A Flume
- Medical University of South Carolina, Charleston, SC, United States.
| | - Elena Amelina
- Pulmonary Research Institute, Moscow, Russian Federation
| | - Cori L Daines
- University of Arizona Department of Pediatrics, Arizona, United States
| | | | | | | | - Moira L Aitken
- University of Washington Medical Center, Seattle, Washington, United States
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Russell JK, Strodl E, Kavanagh D. Use of a Social Robot in the Implementation of a Narrative Intervention for Young People with Cystic Fibrosis: A Feasibility Study. Int J Soc Robot 2021. [DOI: 10.1007/s12369-021-00765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Long term clinical effectiveness of ivacaftor in people with the G551D CFTR mutation. J Cyst Fibros 2020; 20:213-219. [PMID: 33249004 DOI: 10.1016/j.jcf.2020.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, ivacaftor, was first approved for people with CF and the G551D CFTR mutation. This study describes the long-term clinical effectiveness of ivacaftor in this population. METHODS We conducted a multicenter, prospective, longitudinal, observational study of people with CF ages ≥6 years with at least one copy of the G551D CFTR mutation. Measurements of lung function, growth, quality of life, and sweat chloride were performed after ivacaftor initiation (baseline, 1 month, 3 months, 6 months, and annually thereafter until 5.5 years). RESULTS Ninety-six participants were enrolled, with 81% completing all study measures through 5.5 years. This cohort experienced significant improvements in percent predicted forced expiratory volume in 1 second (ppFEV1) of 4.8 [2.6, 7.1] (p < 0.001) at 1.5 years, that diminished to 0.8 [-2.0, 3.6] (p = 0.57) at 5.5 years. Adults experienced larger improvements in ppFEV1 (7.4 [3.6, 11.3], p < 0.001 at 1.5 years and 4.3 [0.6, 8.1], p = 0.02 at 5.5 years) than children (2.8 [0.1, 5.6], p = 0.04 at 1.5 years and -2.0 [-5.9, 2.0], p = 0.32 at 5.5 years). Rate of lung function decline for the overall study cohort from 1 month after ivacaftor initiation through 5.5 years was estimated to be -1.22 pp/year [-1.70, -0.73]. Significant improvements in growth, quality of life measures, sweat chloride, Pseudomonas aeruginosa detection, and pulmonary exacerbation rates requiring antimicrobial therapy persisted through five years of therapy. CONCLUSIONS These findings demonstrate the long-term benefits and disease modifying effects of ivacaftor in children and adults with CF and the G551D mutation.
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34
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van Koningsbruggen-Rietschel S, Davies JC, Pressler T, Fischer R, MacGregor G, Donaldson SH, Smerud K, Meland N, Mortensen J, Fosbøl MØ, Downey DG, Myrset AH, Flaten H, Rye PD. Inhaled dry powder alginate oligosaccharide in cystic fibrosis: a randomised, double-blind, placebo-controlled, crossover phase 2b study. ERJ Open Res 2020; 6:00132-2020. [PMID: 33123558 PMCID: PMC7569163 DOI: 10.1183/23120541.00132-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022] Open
Abstract
Background OligoG is a low molecular-weight alginate oligosaccharide that improves the viscoelastic properties of cystic fibrosis (CF) mucus and disrupts biofilms, thereby potentiating the activity of antimicrobial agents. The efficacy of inhaled OligoG was evaluated in adult patients with CF. Methods A randomised, double-blind, placebo-controlled multicentre crossover study was used to demonstrate safety and efficacy of inhaled dry powder OligoG. Subjects were randomly allocated to receive OligoG 1050 mg per day (10 capsules three times daily) or matching placebo for 28 days, with 28-day washout periods following each treatment period. The primary end-point was absolute change in percentage predicted forced expiratory volume in 1 s (FEV1) at the end of 28-day treatment. The intention-to-treat (ITT) population (n=65) was defined as randomised to treatment with at least one administration of study medication and post-dosing evaluation. Results In this study, 90 adult subjects were screened and 65 were randomised. Statistically significant improvement in FEV1 was not observed in the ITT population. Adverse events included nasopharyngitis, cough and pulmonary exacerbation. The number and proportions of patients with adverse events and serious adverse events were similar between OligoG and placebo group. Conclusions Inhalation of OligoG-dry powder over 28 days was safe in adult CF subjects. Statistically significant improvement of FEV1 was not reached. The planned analyses did not indicate a significant treatment benefit with OligoG compared to placebo. Post hoc exploratory analyses showed subgroup results that indicate that further studies of OligoG in this patient population are justified. Inhalation of OligoG-DPI over 28 days was shown to be safe in adult CF subjects. Statistically significant improvement of FEV1 was not reached. Post hoc subgroup analyses support mechanism of action for OligoG and warrant further prospective studies.https://bit.ly/2PHq6Z0
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Affiliation(s)
| | - Jane C Davies
- Dept of Paediatric Respiratory Medicine, National Heart and Lung Institute, Imperial College London, and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | - Gordon MacGregor
- Dept of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Knut Smerud
- SMERUD Medical Research International AS, Oslo, Norway
| | - Nils Meland
- SMERUD Medical Research International AS, Oslo, Norway
| | - Jann Mortensen
- Copenhagen CF Centre, Rigshospitalet, Copenhagen, Denmark
| | - Marie Ø Fosbøl
- Copenhagen CF Centre, Rigshospitalet, Copenhagen, Denmark
| | - Damian G Downey
- Centre for Experimental Medicine, Queen's University, Belfast, UK
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Kavalieratos D, Georgiopoulos AM, Dhingra L, Basile MJ, Rabinowitz E, Hempstead SE, Faro A, Dellon EP. Models of Palliative Care Delivery for Individuals with Cystic Fibrosis: Cystic Fibrosis Foundation Evidence-Informed Consensus Guidelines. J Palliat Med 2020; 24:18-30. [PMID: 32936045 PMCID: PMC7757696 DOI: 10.1089/jpm.2020.0311] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cystic fibrosis (CF) affects more than 70,000 individuals and their families worldwide. Although outcomes for individuals with CF continue to improve, it remains a life-limiting condition with no cure. Individuals with CF manage extensive symptom and treatment burdens and face complex medical decisions throughout the illness course. Although palliative care has been shown to reduce suffering by alleviating illness-related burdens for people with serious illness and their families, little is known regarding the components and structure of various delivery models of palliative care needed to improve outcomes for people affected by CF. The Cystic Fibrosis Foundation (CFF) assembled an expert panel of clinicians, researchers, individuals with CF, and family caregivers, to develop consensus recommendations for models of best practices for palliative care in CF. Eleven statements were developed based on a systematic literature review and expert opinion, and address primary palliative care, specialty palliative care, and screening for palliative needs. These recommendations are intended to comprehensively address palliative care needs and improve quality of life for individuals with CF at all stages of illness and development, and their caregivers.
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Affiliation(s)
- Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York, USA.,Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Melissa J Basile
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | | | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland, USA
| | - Elisabeth P Dellon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
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36
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Santana NN, Chaves CRMDM, Gonçalves CP, Gomes Junior SCDS. FACTORS ASSOCIATED TO QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS. ACTA ACUST UNITED AC 2020; 38:e2018397. [PMID: 32578674 PMCID: PMC7307721 DOI: 10.1590/1984-0462/2020/38/2018397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Abstract
Objective: To verify the association between quality of life, functional capacity and
clinical and nutritional status in children and adolescents with cystic
fibrosis (CF). Methods: Cross-sectional study, including patients from eight to 18 years old with
CF. Quality of life, functional capacity, nutritional status and clinical
status were evaluated with the Cystic Fibrosis Questionnaire; the 6-minute
walk test (6MWT) and manual gripping force (MGF); the height percentiles for
age and body mass index for age and respiratory function test, respectively.
Pearson and Spearman correlation tests and logistic regression were used to
analyze the data. Results: A total of 45 patients, 13.4±0.5 years old, 60% female, 60% colonized by
Pseudomonas aeruginosa and 57.8% with at least one
F508del mutation participated in the study. When assessing the perception of
quality of life, the weight domain reached the lowest values, and the
digestive domain, the highest. In the pulmonary function test, the forced
expiratory volume of the first second was 77.3±3.3% and the 6MWT and MGF
presented values within the normal range. There was an association between
quality of life and functional capacity, nutritional status and clinical
status of CF patients. Conclusions: The study participants had good clinical conditions and satisfactory values
of functional capacity and quality of life. The findings reinforce that the
assessment of quality of life may be important for clinical practice in the
management of treatment.
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Affiliation(s)
- Nelbe Nesi Santana
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brasil
| | | | - Christine Pereira Gonçalves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro, RJ, Brasil
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Barbato E, Daly B, Douglas S, Kerr M, Litman P, Darrah R. Genetic Variation Near chrXq22-q23 Is Linked to Emotional Functioning in Cystic Fibrosis. Biol Res Nurs 2020; 22:319-325. [PMID: 32390518 DOI: 10.1177/1099800420924125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Cystic fibrosis (CF) is an autosomal recessive disease that affects many organ systems, most notably the pulmonary and gastrointestinal systems. Through genome-wide association studies, multiple genetic regions modifying CF-related pulmonary and gastrointestinal symptoms have been identified, but translation of these findings to clinical benefit remains elusive. Symptom variation in CF patients has been associated with changes in health-related quality of life (HRQOL), but the relationship between CF symptom-modifying genetic loci and HRQOL has not been explored. The purpose of this study was to determine whether two previously identified genetic modifiers of CF-related pathology also modify the subscales of HRQOL. METHODS HRQOL and genotype data were obtained and analyzed. Linear regressions were used to examine the amount of variance in HRQOL subscales that could be explained by genotype for each modifier locus. RESULTS A significant regression equation was found between genotype for rs5952223, a variant near chrXq22-q23, and emotional functioning in a sample of 129 CF patients. DISCUSSION These data suggest that genotype for this single-nucleotide polymorphism is associated with emotional functioning in CF patients and highlight this genetic region as a potential therapeutic target, irrespective of CF transmembrane conductance regulator genotype.
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Affiliation(s)
- Eric Barbato
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Daly
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Sara Douglas
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Kerr
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Paul Litman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca Darrah
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA.,Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Boon M, Calvo-Lerma J, Claes I, Havermans T, Asseiceira I, Bulfamante A, Garriga M, Masip E, van Schijndel BAM, Fornes V, Barreto C, Colombo C, Crespo P, Vicente S, Janssens H, Hulst J, Witters P, Nobili R, Pereira L, Ruperto M, Van der Wiel E, Mainz JG, De Boeck K, Ribes-Koninckx C. Use of a mobile application for self-management of pancreatic enzyme replacement therapy is associated with improved gastro-intestinal related quality of life in children with Cystic Fibrosis. J Cyst Fibros 2020; 19:562-568. [PMID: 32335023 DOI: 10.1016/j.jcf.2020.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency (PI), leading to fat malabsorption, malnutrition, abdominal discomfort and impaired growth. Pancreatic enzyme replacement therapy (PERT) is effective, but evidence based guidelines for dose adjustment are lacking. A mobile app for self-management of PERT was developed in the context of the HORIZON 2020 project MyCyFAPP. It contains an algorithm to calculate individual PERT-doses for optimal fat digestion, based on in vitro and in vivo studies carried out in the same project. In addition, the app includes a symptoms diary, educational material, and it is linked to a web tool allowing health care professionals to evaluate patient's data and provide feedback. METHODS A 6-month open label prospective multicenter interventional clinical trial was performed to assess effects of using the app on gastro-intestinal related quality of life (GI QOL), measured by the CF-PedsQL-GI (shortened, CF specific version of the Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Module). RESULTS One hundred and seventy-one patients with CF and PI between 2 and 18 years were recruited at 6 European CF centers. Self-reported CF-PedsQL-GI improved significantly from month 0 (M0) (84.3, 76.4-90.3) to month 6 (M6) (89.4, 80.35-93.5) (p< 0.0001). Similar improvements were reported by parents. Lower baseline CF-PedsQL-GI was associated with a greater improvement at M6 (p < 0.001). CONCLUSIONS The results suggest that the MyCyFAPP may improve GI QOL for children with CF. This tool may help patients to improve self-management of PERT, especially those with considerable GI symptoms.
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Affiliation(s)
- M Boon
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium.
| | - J Calvo-Lerma
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - I Claes
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - T Havermans
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - I Asseiceira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - A Bulfamante
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Garriga
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Masip
- Gastroenterology and Pediatric cystic Fibrosis Unit, La Fe Hospital, Valencia, Spain
| | - B A M van Schijndel
- Department of Pediatrics, div of Gastro-Enterology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - V Fornes
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - C Barreto
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - C Colombo
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - P Crespo
- Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - S Vicente
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - H Janssens
- Department of Pediatrics, div Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - J Hulst
- Department of Pediatrics, div of Gastro-Enterology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - P Witters
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
| | - R Nobili
- Università degli Studi di Milano, Fondazione IRCCS Ca" Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - L Pereira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - M Ruperto
- Unidad de Fibrosis Quística, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Van der Wiel
- Department of Pediatrics, div Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, University Hospital Rotterdam, the Netherlands
| | - J G Mainz
- Cystic Fibrosis Center for Children and Adults, Jena University Hospital, Germany; Cystic Fibrosis Center Brandenburg Medical School (MHB), University, Brandenburg an der Havel, Germany
| | - K De Boeck
- Department of Pediatrics, Center for Cystic Fibrosis, University Hospital Leuven, Leuven, Belgium
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Borschuk AP, Molitor S, Everhart RS, Siracusa C, Filigno SS. Executive functioning in pediatric cystic fibrosis: A preliminary study and conceptual model. Pediatr Pulmonol 2020; 55:939-947. [PMID: 31951324 DOI: 10.1002/ppul.24648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research has shown that broad cognitive functioning in individuals with CF is intact. Specific executive functioning (EF) deficits have been identified, however, and adults with CF report more symptoms of ADHD than the general population. EF skills are critical to the management of a complex disease like CF although studies have not adequately examined EF mechanisms in CF. This manuscript (a) described EF in a small sample of children with CF, (b) summarized relations found between EF and psychosocial variables, and (c) presented a conceptual model by which to understand EF's impact on adherence in CF. METHODS Data for this preliminary study were collected from 19 children with CF and their caregivers (ages, 6-18). Caregivers completed questionnaires assessing their child's physical and mental health, their own functioning, and overall family functioning. EF was measured using a parent-report rating scale. Patient health data were collected from the electronic medical record. RESULTS This sample did not demonstrate elevated levels of EF impairment. Worse EF was related to poor family communication/cohesion, as well as higher treatment burden, worse lung function, poorer adherence, and older age. From these findings, a preliminary model was developed describing EF in the context of CF and adherence. CONCLUSIONS Findings from this preliminary study suggest that the CF regimen and associated symptoms may overload otherwise adequate EF skills. Reducing disease burden and preventing burnout should be a focus of treatment. A better understanding of EF in CF and the impact on adherence would allow for better clinical management and effective design of interventions.
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Affiliation(s)
- Adrienne P Borschuk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephen Molitor
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Christopher Siracusa
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Changes in the parent cystic fibrosis questionnaire-revised (CFQ-R) with respiratory symptoms in preschool children with cystic fibrosis. J Cyst Fibros 2020; 19:492-498. [PMID: 32139196 DOI: 10.1016/j.jcf.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The Cystic Fibrosis Questionnaire-Revised (CFQ-R) Respiratory score is a validated and widely used patient-reported outcome. This study aimed to establish changes in the score with acute respiratory events in preschool children with CF and to investigate its' relationship with physiological outcomes. METHODS The Parent CFQ-R, multiple breath washout test and spirometry were performed at six study visits over one year. The clinical status of participants, stable or symptomatic, was defined by the patient's physician. Linear regression and distribution-based statistical methods were used to examine the changes in the CFQ-R from the last stable visit and to investigate its relationship with physiological outcomes. RESULTS There were 272 stable and 115 symptomatic visits from 78 participants. The mean CFQ-R Respiratory score did not change between consecutive stable visits (-0.73, SD 20.4). The mean (SD) score deteriorated by 15.5 (20.7) points between stable and symptomatic visits and improved by 14.8 (20.1) points between symptomatic and stable follow-up visits. When a clinically important change is defined as 0.5SD change (10-points), the positive predictive value (PPV) was 45% and the negative predictive value (NPV) was 84%. For visits with a 10-point worsening in the CFQ-R Respiratory score and a 15% increase in LCI, the PPV was better (81%) than using either measure alone. CONCLUSION The CFQ-R Respiratory score is responsive to acute respiratory events in preschool children with CF and its utility to monitor individual patients is improved when combined with LCI.
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Boon M, Claes I, Havermans T, Fornés-Ferrer V, Calvo-Lerma J, Asseiceira I, Bulfamante A, Garriga M, Masip E, Woodcock S, Walet S, Barreto C, Colombo C, Crespo P, Van der Wiel E, Hulst J, Martinez-Barona S, Nobili R, Pereira L, Ruperto M, Vicente S, De Boeck K, Ribes-Koninckx C. Assessing gastro-intestinal related quality of life in cystic fibrosis: Validation of PedsQL GI in children and their parents. PLoS One 2019; 14:e0225004. [PMID: 31860639 PMCID: PMC6924691 DOI: 10.1371/journal.pone.0225004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most patients with cystic fibrosis (CF) suffer from pancreatic insufficiency, leading to fat malabsorption, malnutrition and abdominal discomfort. Until recently, no specific tool was available for assessing gastro-intestinal related quality of life (GI QOL) in patients with CF. As the Horizon2020 project MyCyFAPP aims to improve GI QOL by using a newly designed mobile application, a sensitive and reliable outcome measure was needed. We aimed to study the applicability of the existing child-specific Pediatric Quality of Life Inventory, Gastrointestinal Symptoms Scales and Module (PedsQL GI) in children with CF. METHODS A multicenter, prospective observational study was performed in 6 European centers to validate the PedsQL GI in children with CF during 3 months. RESULTS In total, 248 children and their parents were included. Within-patient variability of PedsQL GI was low (24.11), and there was reasonable agreement between children and parents (ICC 0.681). Nine of 14 subscales were informative (no ceiling effect). The PedsQL GI and the median scores for 4 subscales were significantly lower in patients compared to healthy controls. Positive associations were found between PedsQL GI and age (OR = 1.044, p = 0.004) and between PedsQL GI and BMI z-score (OR = 1.127, p = 0.036). PedsQL GI correlated with most CFQ-R subscales (r 0.268 to 0.623) and with a Visual Analogue Scale (r = 0.20). CONCLUSIONS PedsQL GI is a valid and applicable instrument to assess GI QOL in children with CF. Future research efforts should examine the responsiveness of the CF PedsQL GI to change in the context of clinical interventions and trials.
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Affiliation(s)
- Mieke Boon
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
- * E-mail:
| | - Ine Claes
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Trudy Havermans
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Inês Asseiceira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Anna Bulfamante
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Etna Masip
- Instituto de Investigación Sanitaria La Fe de Valencia, Spain
| | - Sandra Woodcock
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Sylvia Walet
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Celeste Barreto
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Carla Colombo
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paula Crespo
- Instituto de Investigación Sanitaria La Fe de Valencia, Spain
| | - Els Van der Wiel
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Jessie Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, Netherlands
| | | | - Rita Nobili
- Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luisa Pereira
- Associação para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Mar Ruperto
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Kris De Boeck
- Cystic Fibrosis Center, Department of Pediatrics, University Hospital Gasthuisberg, Leuven, Belgium
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Health-Related Quality of Life Instruments for Children With Cochlear Implants: Development of Child and Parent-Proxy Measures. Ear Hear 2019; 40:592-604. [PMID: 30059365 DOI: 10.1097/aud.0000000000000631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Severe to profound hearing loss is associated with worse health-related quality of life (HRQoL), reflecting the wide-ranging effects of deafness on spoken language, cognition, and social/behavioral development. However, there are currently no cochlear implant (CI)-specific HRQoL measures that were developed using the Food and Drug Administration Guidance on patient-reported outcomes. This study developed the first HRQoL instruments (CI-QoL) for children with CIs, ages 6 to 12, and a parent-proxy measure for this age group. DESIGN Two phases of instrument development were conducted. Phase 1 consisted of a literature review yielding a conceptual framework and discussion guides to elicit information from stakeholder focus groups at CI clinics in Miami and Philadelphia (n = 30; e.g., physicians, speech pathologists). During phase 2, open-ended interviews were conducted with 21 parent-child dyads (M child age = 9.1 years) recruited from these two clinics. Interviews were transcribed, followed by content analysis in NVivo to identify the most frequent and difficult themes. Items were then derived from these themes to form the initial draft instruments. A multimodal approach was used to create the child-report version (i.e., pictorial representations, audio recording of items, written text above the drawings) to maximize comprehension and ease of responding. Both measures were developed to be administered electronically on a tablet device. In phase 3, a new set of parent-child dyads (n = 20; child age M = 9.2 years) completed a cognitive testing protocol to ensure clarity, ease of use, and comprehensiveness. Cognitive testing led to revisions and finalization of the instruments. RESULTS The final self-report measure contained 33 items across eight domains: Noisy Environments, Academic Functioning, Child Acceptance, Oral Communication, Social Functioning, Fatigue, Emotional Functioning, and Device Management. The final parent-proxy measure included 42 items on nine scales: the same eight scales that appear on the child version, with the addition of Behavior Problems. Correlations between child and parent reports on each scale ranged from r = 0.08 to 0.48. CONCLUSIONS CI-specific HRQoL instruments have now been developed for school-age children with CIs, with an accompanying parent-proxy version. After a psychometric validation, these CI-specific measures will enable us to track long-term outcomes, evaluate the efficacy of interventions to improve CI use (e.g., single versus bilateral implantation, AV therapy, maternal sensitivity training), and provide a profile of the "whole child's" functioning to facilitate care.
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Russell JK, Strodl E, Connolly J, Kavanagh DJ. A Metacognitive Intervention of Narrative Imagery for young people with cystic fibrosis: A feasibility study. J Health Psychol 2019; 26:1389-1403. [PMID: 31530184 DOI: 10.1177/1359105319876336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cystic fibrosis and its treatment can have substantial functional and emotional impacts on patients and their families. This feasibility study assessed a new cystic fibrosis treatment, Metacognitive Intervention of Narrative Imagery, integrating narrative and meta-cognitive therapies with mental imagery. A total of 13 patients, aged 10-17 years, received three 1-hour sessions and were assessed on emotional functioning, anxiety, and depression at baseline and 4 and 8 weeks post-baseline. Participants had significant improvements in anxiety, and changes in emotional functioning and anxiety had a medium effect size. Participants and parents rated Metacognitive Intervention of Narrative Imagery highly on usability and favourability. Further clinical trials are indicated.
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Filigno SS, Miller J, Moore S, Peugh J, Weiland J, Backstrom J, Borschuk A. Assessing psychosocial risk in pediatric cystic fibrosis. Pediatr Pulmonol 2019; 54:1391-1397. [PMID: 31237431 DOI: 10.1002/ppul.24414] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/26/2019] [Accepted: 05/24/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psychosocial risk factors are known to impact quality of life, treatment adherence, and health outcomes. No standardized comprehensive psychosocial risk screener is routinely utilized in cystic fibrosis (CF) care. The objectives of the study were to describe the range and severity of psychosocial risk within this CF population, investigate the reliability of a comprehensive psychosocial screener in pediatric CF clinical care, and explore relationships between psychosocial risk and key factors affecting health outcomes. It was hypothesized that the PAT-CF total and subscale α coefficients would be similar to those found in other pediatric medical populations. METHOD Parents of 154 children with CF completed a CF-specific version of the Psychosocial Assessment Tool_All-lit (PAT-CF), an empirically-based psychosocial risk assessment, during routine CF clinical care. RESULTS The internal consistency of the PAT-CF Total score was 0.71. Total score and subscale reliabilities reflect findings in other pediatric populations. Total risk scores fell in the following categories: 7% (Clinical-highest risk), 41% (Targeted), and 52% (Universal-lowest risk), respectively. Increased psychosocial risk was associated with Medicaid status and lower parent education, whereas having private insurance was associated with decreased psychosocial risk. CONCLUSIONS The PAT-CF can feasibly be used as an empirically-based comprehensive psychosocial risk tool in routine CF care and is acceptable by parents. In addition to providing universal anticipatory guidance regarding child and family wellness, early identification of risk factors allows care teams to proactively provide targeted support and intervention for specific psychosocial risk factors to promote improved quality of life and ability to sustain daily care.
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Affiliation(s)
- Stephanie S Filigno
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jamie Miller
- Division of Social Work, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susan Moore
- Division of Social Work, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James Peugh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeanne Weiland
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Adrienne Borschuk
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Dhingra L, Walker P, Berdella M, Plachta A, Chen J, Fresenius A, Balzano J, Barrett M, Bookbinder M, Wilder K, Glajchen M, Langfelder-Schwind E, Portenoy RK. Addressing the burden of illness in adults with cystic fibrosis with screening and triage: An early intervention model of palliative care. J Cyst Fibros 2019; 19:262-270. [PMID: 31471264 DOI: 10.1016/j.jcf.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Novel models that improve generalist-level palliative care for cystic fibrosis (CF) are needed to address the burden of this illness. A screening-and-triage model has the potential to identify clinical problems requiring immediate follow-up by CF professionals. This study describes such a model and its immediate impact on care delivery for CF patients during a two-year period. METHODS Eligible adults completed monthly online screening for sources of distress. If results revealed one or more "indicators of concern" on two consecutive screenings, this triggered an attempted triage by a social worker. Completed triages led to prompt follow-up by CF professionals for clinical problems, if indicated. Process data were summarized and generalized linear mixed models were used to evaluate baseline patient characteristics (symptom distress, quality of life, and sociodemographics) associated with the need for prompt follow-up. RESULTS A total of 1,015 monthly surveys were completed by 74 patients; 634 (66 patients) had >1 indicators of concern; and 164 surveys (46 patients) had >1 indicators for two consecutive surveys (e.g., global distress, pain, dyspnea, and psychological symptoms). The 164 attempted triages yielded 84 completed triages (51.2%), of which 39 (46.4%) required prompt follow-up. In multivariable analyses, older patients and those with higher symptom distress at baseline were more likely to require prompt follow-up (p < .05). CONCLUSIONS Web-based screening that assesses varied domains of distress or burden can identify a subset of CF patients whose clinical problems may benefit from immediate medical or psychological attention. Additional investigations should improve screening efficiency.
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Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA.
| | - Patricia Walker
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Maria Berdella
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Amy Plachta
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Ashley Fresenius
- Southern Nevada Adult Mental Health Services, 6161 W. Charleston Blvd, Las Vegas, NV 89146, USA
| | - Julie Balzano
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Malcolm Barrett
- University of Southern California, Los Angeles, CA 90007, USA
| | - Marilyn Bookbinder
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Kenya Wilder
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
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Bilton D, Pressler T, Fajac I, Clancy JP, Sands D, Minic P, Cipolli M, Galeva I, Solé A, Quittner AL, Liu K, McGinnis JP, Eagle G, Gupta R, Konstan MW. Amikacin liposome inhalation suspension for chronic Pseudomonas aeruginosa infection in cystic fibrosis. J Cyst Fibros 2019; 19:284-291. [PMID: 31451351 DOI: 10.1016/j.jcf.2019.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/27/2019] [Accepted: 08/01/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Shortcomings of inhaled antibiotic treatments for Pseudomonas aeruginosa infection in patients with cystic fibrosis (CF) include poor drug penetration, inactivation by sputum, poor efficiency due to protective biofilm, and short residence in the lung. METHODS Eligible patients with forced expiratory volume in 1 s (FEV1) ≥25% of predicted value at screening and CF with chronic P. aeruginosa infection were randomly assigned to receive 3 treatment cycles (28 days on, 28 days off) of amikacin liposome inhalation suspension (ALIS, 590 mg QD) or tobramycin inhalation solution (TIS, 300 mg BID). The primary endpoint was noninferiority of ALIS vs TIS in change from baseline to day 168 in FEV1 (per-protocol population). Secondary endpoints included change in respiratory symptoms by Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS The study was conducted February 2012 to September 2013. ALIS was noninferior to TIS (95% CI, -4.95 to 2.34) for relative change in FEV1 (L) from baseline. The mean increases in CFQ-R score from baseline on the Respiratory Symptoms scale suggested clinically meaningful improvement in both arms at the end of treatment in cycle 1 and in the ALIS arm at the end of treatment in cycles 2 and 3; however, the changes were not statistically significant between the 2 treatment arms. Treatment-emergent adverse events (TEAEs) were reported in most patients (ALIS, 84.5%; TIS, 78.8%). Serious TEAEs occurred in 17.6% and 19.9% of patients, respectively; most were hospitalisations for infective pulmonary exacerbation of CF. CONCLUSIONS Cyclical dosing of once-daily ALIS was noninferior to cyclical twice-daily TIS in improving lung function. ClinicalTrials.gov Identifier: NCT01315678.
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Affiliation(s)
| | | | | | - John Paul Clancy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, Warsaw, Poland
| | - Predrag Minic
- Institute for Mother and Child Health Care, Department of Pulmonology, Medical School University of Belgrade, Serbia
| | - Marco Cipolli
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Ivanka Galeva
- Pediatric Clinic, Infants Department, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Amparo Solé
- Lung Transplant and Cystic Fibrosis Unit, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Keith Liu
- Insmed Incorporated, Bridgewater, NJ, USA
| | | | - Gina Eagle
- Insmed Incorporated, Bridgewater, NJ, USA
| | - Renu Gupta
- Insmed Incorporated, Bridgewater, NJ, USA
| | - Michael W Konstan
- Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Hong G, Alby K, Ng SCW, Fleck V, Kubrak C, Rubenstein RC, Dorgan DJ, Kawut SM, Hadjiliadis D. The presence of Aspergillus fumigatus is associated with worse respiratory quality of life in cystic fibrosis. J Cyst Fibros 2019; 19:125-130. [PMID: 31446018 DOI: 10.1016/j.jcf.2019.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/09/2019] [Accepted: 08/12/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND The clinical effects of Aspergillus fumigatus in the cystic fibrosis (CF) airway, with the exception of allergic bronchopulmonary aspergillosis, is unclear. METHODS CF adolescents and adults (age 14 years and older) underwent bacterial and semi-selective fungal culture testing to determine the prevalence of fungi in the CF respiratory tract and the independent association between the presence of Aspergillus fumigatus and clinical characteristics. RESULTS Aspergillus fumigatus (10.3%) and Candida species (57.8%) were the most common filamentous fungi and yeast seen respectively in the sputa of 206 individuals with CF. Inhaled corticosteroid (ICS) use was more common in Aspergillus fumigatus-positive than Aspergillus fumigatusnegative (100% versus 75.8%, p = .01). Aspergillus fumigatus was significantly associated with lower respiratory domain score (β -8.74, 95% CI -16.6, -0.88, p = .03), representing worse respiratory-related quality of life, accounting for demographics, disease characteristics, and the presence of a pulmonary exacerbation. CONCLUSION The presence of Aspergillus fumigatus in CF sputum was associated with worse respiratory quality of life in CF in a crosssectional, single center study. Longitudinal analysis examining the clinical implications of Aspergillus fumigatus on respiratory health over time is needed.
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Affiliation(s)
- Gina Hong
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Kevin Alby
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharon C W Ng
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Victoria Fleck
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Christina Kubrak
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronald C Rubenstein
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel J Dorgan
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Steven M Kawut
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Denis Hadjiliadis
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Cochrane Database Syst Rev 2019; 5:CD012578. [PMID: 31119726 PMCID: PMC6531890 DOI: 10.1002/14651858.cd012578.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS Two authors independently reviewed papers identified in the searches. MAIN RESULTS No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.
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Affiliation(s)
- Helen Malone
- Trinity College DublinSchool of Nursing & Midwifery24 D’Olier Street, College GreenDublin 2Ireland
| | - Susan Biggar
- Australian Health Practitioner Regulation Agency (AHPRA)111 Burke Street, Level 7MelbourneAustraliaVIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, CrumlinDepartment of Respiratory MedicineDublinIreland12
| | - Zai Edworthy
- Temple Street Children's University HospitalDepartment of PsychologyTemple StreetDublinIrelandDO1 YC67
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
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Quittner AL, Eakin MN, Alpern AN, Ridge AK, McLean KA, Bilderback A, Criado KK, Chung SE, Riekert KA. Clustered randomized controlled trial of a clinic-based problem-solving intervention to improve adherence in adolescents with cystic fibrosis. J Cyst Fibros 2019; 18:879-885. [PMID: 31103533 DOI: 10.1016/j.jcf.2019.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Cystic Fibrosis (CF), adherence to pulmonary medications is about 50% and decreases during adolescence. Effective interventions have not been integrated into CF care. This effectiveness study tested a brief, clinic-based behavioral intervention to improve adherence. METHODS iCARE (I Change Adherence and Raise Expectations) was a pragmatic, clustered, 2-arm randomized controlled trial at 18 CF Centers. 607 adolescents with CF, ages 11-20 years, participated. Centers were randomized to IMPACT (n = 9; 300 adolescents), a brief problem-solving + education intervention, or standard care (SC; n = 9; 307 adolescents). IMPACT was delivered during a regularly scheduled clinic visit by a member of the clinical care team. The primary outcome was composite pulmonary medication possession ratio (cMPR); secondary endpoints were lung function, Body Mass Index percentile, courses of IV antibiotics, and health-related quality of life at 12 months. RESULTS Effectiveness of the intervention was tested using mixed models, generalized estimating equations comparing IMPACT to SC. Fifty-eight percent of problem-solving sessions targeted barriers to airway clearance, exercise or nutrition, while 18% addressed pulmonary medications. Average intervention fidelity score was 67% (SD = 14%; Range = 25-100%). No significant intervention effects were found for cMPR or any of the secondary outcomes compared to SC. CONCLUSIONS The IMPACT intervention did not improve medication adherence or health outcomes over 12 months. Challenges to implementing the intervention as intended during busy clinic visits were identified. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01232478; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Alexandra L Quittner
- Nicklaus Children's Research Institute, Nicklaus Children's Hospital, Miami, FL, USA.
| | - Michelle N Eakin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Adrianne N Alpern
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Alana K Ridge
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Katherine A McLean
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Andrew Bilderback
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Kristen K Criado
- Department of Psychology, University of Miami, P.O. Box 248185, Miami, FL, USA
| | - Shang-En Chung
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
| | - Kristin A Riekert
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA
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50
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Tomlinson OW, Shelley J, Trott J, Bowhay B, Chauhan R, Sheldon CD. The feasibility of online video calling to engage patients with cystic fibrosis in exercise training. J Telemed Telecare 2019; 26:356-364. [DOI: 10.1177/1357633x19828630] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Physical activity, including structured exercise, is an essential component in the management of cystic fibrosis. The use of telehealth such as video-calling may be a useful method for the delivery of exercise and physical activity interventions, though the feasibility of this remains unknown. Methods Nine patients with cystic fibrosis (three female, six male, 30.9 ± 8.7 years) volunteered to participate. Participants completed an eight-week exercise training intervention conducted via Skype, using personalised exercises, with all sessions supervised by an exercise therapist. Feasibility was assessed by demand, implementation, practicality and acceptability. Changes in anthropometric, pulmonary, physical activity and quality of life variables were also assessed. Results Two male participants withdrew from the study, citing lack of available time. The remaining participants found use of Skype useful, with a mean satisfaction rating of 9/10, and three participants requesting to continue the sessions beyond the duration of the study. Mean compliance with sessions was 68%, with mean duration of sessions being 20 min. A total of 25% of calls suffered from technical issues such as video or audio lags. Anthropometric, pulmonary, physical activity and quality of life variables remained unchanged over the course of the study period. Discussion The use of Skype to deliver an exercise intervention to patients withcystic fibrosis was found to be technologically feasible, and acceptable among participants. Findings have implications for clinical practice and could allow care teams to engage patients remotely in exercise. Further research is required to assess the efficacy of this modality on increasing physical activity and associated health outcomes.
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Affiliation(s)
- Owen W Tomlinson
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Sport and Health Science, University of Exeter, UK
| | - James Shelley
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Jayne Trott
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Ben Bowhay
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
- Department of Physiotherapy, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Rohan Chauhan
- Research and Development Directorate, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
| | - Christopher D Sheldon
- Department of Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust Hospital, UK
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